Healthcare Provider Details

I. General information

NPI: 1194173252
Provider Name (Legal Business Name): NICOLE MARIE DIAZ-RAMOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 05/30/2023
Certification Date: 05/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

METROPOLITAN HOSPITAL DR. SUSONI #55 CALLE PALMA
ARECIBO PR
00612
US

IV. Provider business mailing address

BARRIO MONACILLOS CARR. 22, CENTRO MEDICO HOSPITAL PEDIATRICO UNIVERSITARIO DR. ANTONIO ORTIZ
RIO PIEDRAS PR
00935
US

V. Phone/Fax

Practice location:
  • Phone: 787-539-3554
  • Fax:
Mailing address:
  • Phone: 787-753-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21241
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number21241
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: