Healthcare Provider Details

I. General information

NPI: 1457344509
Provider Name (Legal Business Name): JOEL RAMOS AYALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date: 03/27/2006
Reactivation Date: 04/07/2006

III. Provider practice location address

CALLE PARANA 1716 URB. EL CEREZAL
SAN JUAN PR
00926-3148
US

IV. Provider business mailing address

CALLE PARANA 1716 EL CEREZAL
SAN JUAN PR
00926-3148
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-2200
  • Fax: 787-766-8548
Mailing address:
  • Phone: 787-766-2200
  • Fax: 787-766-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11877
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207UN0903X
TaxonomyIn Vivo & In Vitro Nuclear Medicine Physician
License Number11877
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: