MEDICARE: RAMON ANTONIO SOLIVAN MIRANDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	271	PR

General Provider Information

NPI Number	:	1851375588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMON ANTONIO SOLIVAN MIRANDA

Provider Business Mailing Address
First Line	:	PO BOX 1866
Second Line	:	1 MARIO BRASCHI ST
City	:	COAMO
State	:	PR
Zip	:	00769-1866
Country	:	US
Telephone Number	:	787-825-1184
Fax Number	:	787-825-1184

Provider Business Practice Location Address
First Line	:	1 CALLE MARIO BRASCHI
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2501
Country	:	US
Telephone Number	:	787-825-1184
Fax Number	:	787-825-1184

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. RAMON A SOLIVAN
Credential	:
Telephone Number	:	787-825-1184

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	06/24/2008

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