=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932175635
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IVETTE HERNANDEZ-RAMIREZ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111-50 AVE. ROBERTO CLEMENTE , LOCAL 1, VILLA CAROLINA,
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-750-4920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30-22 CALLE 10 VILLA CAROLINA,
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00985-5426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-776-1672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 16321
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------