=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083760821
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHANNA GRISELL RAMOS BELEN OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 02/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 53 CALLE CORAL REPTO PUEBLO NUEVO
-----------------------------------------------------
City | SAN GERMAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00683-4306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-410-5774
-----------------------------------------------------
Fax | 787-833-9200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CORAL 53 REPTO PUEBLO NUEVO
-----------------------------------------------------
City | SAN GERMAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-410-5774
-----------------------------------------------------
Fax | 787-833-9200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 551
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------