Healthcare Provider Details

I. General information

NPI: 1366169625
Provider Name (Legal Business Name): RANDY MARCELL MORAN RAMOS PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 05/13/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 CALLE DE LA TANCA
SAN JUAN PR
00901-1412
US

IV. Provider business mailing address

151 CALLE DE LA TANCA
SAN JUAN PR
00901-1412
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-6500
  • Fax:
Mailing address:
  • Phone: 939-353-6123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7988
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: