Provider Demographics
NPI:1063686582
Name:RAYOS, JOSE ROMMEL MONTANO (IDC)
Entity Type:Individual
Prefix:MR
First Name:JOSE ROMMEL
Middle Name:MONTANO
Last Name:RAYOS
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 561
Mailing Address - Street 2:BOX 1877
Mailing Address - City:YAMAGUCHI
Mailing Address - State:FPO AP
Mailing Address - Zip Code:96310 0019
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 561
Practice Address - Street 2:BOX 1877
Practice Address - City:YAMAGUCHI
Practice Address - State:FPO AP
Practice Address - Zip Code:96310 0019
Practice Address - Country:JP
Practice Address - Phone:315-253-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman