Healthcare Provider Details

I. General information

NPI: 1689888133
Provider Name (Legal Business Name): ODILY RAMOS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GUARIONEX ST. #7 LOCAL # 2
HATO REY PR
00917
US

IV. Provider business mailing address

LAS CUMBRES #497, EMILIANO POL ST. PMB-383
SAN JUAN PR
00926-5636
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-7695
  • Fax: 787-767-7806
Mailing address:
  • Phone: 939-389-0327
  • Fax: 787-767-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2587
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: