Healthcare Provider Details

I. General information

NPI: 1811058324
Provider Name (Legal Business Name): MARIO R RAMIREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE AUXILLO MUTUO SUITE 815 AVE PONCE DE LEON #735
SAN JUAN PR
00917-0815
US

IV. Provider business mailing address

PASEO MAYOR C 35 CALLE 10
SAN JUAN PR
00926-4670
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-2274
  • Fax: 787-756-7367
Mailing address:
  • Phone: 787-748-2733
  • Fax: 787-756-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5357
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: