Healthcare Provider Details

I. General information

NPI: 1821750654
Provider Name (Legal Business Name): WANDA PACHECO RAMOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 AVE MARUCA
PONCE PR
00728-4103
US

IV. Provider business mailing address

2706 AVE MARUCA
PONCE PR
00728-4103
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-5978
  • Fax: 787-812-5966
Mailing address:
  • Phone: 787-812-5978
  • Fax: 787-812-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number71765
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: