Healthcare Provider Details

I. General information

NPI: 1659316966
Provider Name (Legal Business Name): SAN JUAN VA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E20 CALLE PICASSO QUINTAS DE SAN LUIS
CAGUAS PR
00725-7623
US

IV. Provider business mailing address

E20 CALLE PICASSO QUINTAS DE SAN LUIS
CAGUAS PR
00725-7623
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-2975
  • Fax: 787-641-4380
Mailing address:
  • Phone: 787-641-2975
  • Fax: 787-641-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7605
License Number StatePR

VIII. Authorized Official

Name: DR. CARLOS RAMIREZ
Title or Position: STAFF SURGEON
Credential: MD
Phone: 787-641-2975