Healthcare Provider Details

I. General information

NPI: 1770931321
Provider Name (Legal Business Name): RAMON E. ESPADA GONZALEZ MASTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVE. NORFRE TERRAZAS MONTE CASINO APT. 703
TOA BAJA PR
00949
US

IV. Provider business mailing address

PO BOX 361238
SAN JUAN PR
00936-1238
US

V. Phone/Fax

Practice location:
  • Phone: 787-477-1481
  • Fax:
Mailing address:
  • Phone: 787-477-1481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19975
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: