=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730378258
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ENRIQUE CAPO-RAMOS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2007
-----------------------------------------------------
Last Update Date | 10/22/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | COND TORRE DE LOS FRAILES #2080, APT 5H, CARR 8177
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00966-3735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-777-3535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 71325 PMB 139
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936-8425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-248-1740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 11716-I
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------