Healthcare Provider Details

I. General information

NPI: 1245875889
Provider Name (Legal Business Name): WILMARIE RAMIREZ BURGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 164 SECTPR EL DESVIO, BO. ACHIOTE
NARANJITO PR
00719
US

IV. Provider business mailing address

277 CALLE GEORGETOWN
SAN JUAN PR
00927-4114
US

V. Phone/Fax

Practice location:
  • Phone: 787-869-1290
  • Fax: 787-869-1800
Mailing address:
  • Phone: 787-361-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23424
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: