Healthcare Provider Details

I. General information

NPI: 1316010879
Provider Name (Legal Business Name): RAMON A BENCOSME MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 10 MORELL CAMPOS LOCAL 4 PLAZOLETA CASH AND CARRY
PONCE PR
00732
US

IV. Provider business mailing address

PLAZOLETA CASH AND CARRY MORELL CAMPOS #4 627
PONCE PR
00732
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3193
  • Fax:
Mailing address:
  • Phone: 787-812-3193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8424
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: