Healthcare Provider Details

I. General information

NPI: 1356315196
Provider Name (Legal Business Name): RAMON E VIDAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 DE DIEGO STREET TORRE SAN FRANCISCO SUITE 508
SAN JUAN PR
00923-0000
US

IV. Provider business mailing address

PO BOX 9784
SAN JUAN PR
00908-0784
US

V. Phone/Fax

Practice location:
  • Phone: 787-282-3000
  • Fax: 787-767-2272
Mailing address:
  • Phone: 787-282-3000
  • Fax: 787-767-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8798
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: