Healthcare Provider Details

I. General information

NPI: 1881947711
Provider Name (Legal Business Name): RONNY G OLMOS SW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JARDINES DE BERWIND EDF.O APT.163
SAN JUAN PR
00924
US

IV. Provider business mailing address

PO BOX 30616
SAN JUAN PR
00929-1616
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-0591
  • Fax:
Mailing address:
  • Phone: 787-768-0591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16537
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: