Healthcare Provider Details

I. General information

NPI: 1851375588
Provider Name (Legal Business Name): RAMON ANTONIO SOLIVAN MIRANDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE MARIO BRASCHI
COAMO PR
00769-2501
US

IV. Provider business mailing address

PO BOX 1866 1 MARIO BRASCHI ST
COAMO PR
00769-1866
US

V. Phone/Fax

Practice location:
  • Phone: 787-825-1184
  • Fax: 787-825-1184
Mailing address:
  • Phone: 787-825-1184
  • Fax: 787-825-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number271
License Number StatePR

VIII. Authorized Official

Name: DR. RAMON A SOLIVAN
Title or Position: DIRECTOR
Credential:
Phone: 787-825-1184