Healthcare Provider Details

I. General information

NPI: 1275321887
Provider Name (Legal Business Name): CARLA SOFIA RAMIREZ RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA PR-188 INTERSECCION PR-187
LOIZA PR
00772
US

IV. Provider business mailing address

CALLE TULSA 306, SAN GERARDO
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-876-2042
  • Fax:
Mailing address:
  • Phone: 787-363-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3597
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: