Healthcare Provider Details

I. General information

NPI: 1194987552
Provider Name (Legal Business Name): INGRID J. RAMIREZ DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BYP
PONCE PR
00717-1321
US

IV. Provider business mailing address

PO BOX 7521
PONCE PR
00732-7521
US

V. Phone/Fax

Practice location:
  • Phone: 917-684-4285
  • Fax:
Mailing address:
  • Phone: 917-684-4285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number19918
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME112166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: