Healthcare Provider Details

I. General information

NPI: 1457904591
Provider Name (Legal Business Name): GLORIAN RAMON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CALLE ANDRES ARUZ
GURABO PR
00778
US

IV. Provider business mailing address

22 ESTANCIAS MONTESOL
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-448-6419
  • Fax:
Mailing address:
  • Phone: 787-359-7106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6411
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: