Healthcare Provider Details

I. General information

NPI: 1952613341
Provider Name (Legal Business Name): ILEANA RAMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BQ4 CALLE 109 VALLE ARRIBA HEIGTHS
CAROLINA PR
00983-3318
US

IV. Provider business mailing address

BQ4 CALLE 109 VALLE ARRIBA HEIGTHS
CAROLINA PR
00983-3318
US

V. Phone/Fax

Practice location:
  • Phone: 787-307-7537
  • Fax:
Mailing address:
  • Phone: 787-307-7537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3642
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: