=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578633327
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OSVALDO ORENGO-RAMOS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 09/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 #213 JARDINES DEL CARIBE
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-432-5672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB. VALLE ESCONDIDO #1
-----------------------------------------------------
City | RINCON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-432-5672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 006156
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------