Healthcare Provider Details

I. General information

NPI: 1902893381
Provider Name (Legal Business Name): JORGE R. RAMIREZ-MONTALVO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET PEDRO VELAZQUEZ NO 628 EDIF AURORA A9
PENUELAS PR
00624
US

IV. Provider business mailing address

PO BOX 560102
GUAYANILLA PR
00656-0102
US

V. Phone/Fax

Practice location:
  • Phone: 787-386-2686
  • Fax:
Mailing address:
  • Phone: 787-835-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number16072
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: