=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366485500
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADA A RAMIREZ-SANTIAGO MSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 TITE CURET ALONSO
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00730-0550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-546-4359
-----------------------------------------------------
Fax | 787-259-4938
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 777 TITE CURET ALONSO
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00730-0550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-546-4359
-----------------------------------------------------
Fax | 787-259-4938
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 7037
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------