Healthcare Provider Details

I. General information

NPI: 1033467279
Provider Name (Legal Business Name): CARLOS JUAN RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 CALLE PASADENA URB DORITAS GARDEN
ISABELA PR
00662
US

IV. Provider business mailing address

403 CALLE PASADENA URB. DORITAS GARDEN
ISABELA PR
00662
US

V. Phone/Fax

Practice location:
  • Phone: 787-566-4219
  • Fax:
Mailing address:
  • Phone: 787-566-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4218
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6117
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: