Healthcare Provider Details

I. General information

NPI: 1518956457
Provider Name (Legal Business Name): EDGAR JACINTO RAMOS MENDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 682 KW 3,5
BARCELONETA PR
00617
US

IV. Provider business mailing address

PO BOX 153
BARCELONETA PR
00617-0153
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-3649
  • Fax: 787-623-2849
Mailing address:
  • Phone: 787-846-3649
  • Fax: 787-623-2849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12615
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: