Healthcare Provider Details

I. General information

NPI: 1932175635
Provider Name (Legal Business Name): IVETTE HERNANDEZ-RAMIREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111-50 AVE. ROBERTO CLEMENTE , LOCAL 1, VILLA CAROLINA,
CAROLINA PR
00985
US

IV. Provider business mailing address

30-22 CALLE 10 VILLA CAROLINA,
CAROLINA PR
00985-5426
US

V. Phone/Fax

Practice location:
  • Phone: 787-750-4920
  • Fax:
Mailing address:
  • Phone: 787-776-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16321
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: