Healthcare Provider Details

I. General information

NPI: 1578606836
Provider Name (Legal Business Name): LYSELLE RAMIREZ COREANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYSELLE RAMIREZ COREANO MD

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MIGRANT HEALTH CENTER, INC. 392 SUR CALLE RAMON EMETERIO BETANCES
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

MIGRANT HEALTH CENTER, INC. P O BOX 7128
MAYAGUEZ PR
00681-7128
US

V. Phone/Fax

Practice location:
  • Phone: 787-805-2900
  • Fax: 787-834-1924
Mailing address:
  • Phone: 787-805-2900
  • Fax: 787-834-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11967
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: