Healthcare Provider Details

I. General information

NPI: 1588585400
Provider Name (Legal Business Name): SAMUEL COTTO RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO CASA OLIVA, UBICADO EN LA CALLE LAMELA 153
QUEBRADILLA PR
00662
US

IV. Provider business mailing address

3623 AVE. MILITAR SUITE 101, PMB 400
ISABELA PR
00662
US

V. Phone/Fax

Practice location:
  • Phone: 939-717-0668
  • Fax:
Mailing address:
  • Phone: 939-717-0668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9009
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: