Healthcare Provider Details

I. General information

NPI: 1245436849
Provider Name (Legal Business Name): VIOLA RAMOS JORDAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 CALLE CESAR GONZALEZ PARQUE DE LAS FUENTES, APT. 1507
SAN JUAN PR
00918-3901
US

IV. Provider business mailing address

690 CALLE CESAR GONZALEZ PARQUE DE LAS FUENTES, APT. 1507
SAN JUAN PR
00918-3901
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-6036
  • Fax:
Mailing address:
  • Phone: 787-753-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number2819
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: