Provider Demographics
NPI:1083696629
Name:RAMIREZ, IVELISSE (MD)
Entity Type:Individual
Prefix:DR
First Name:IVELISSE
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364203
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4203
Mailing Address - Country:US
Mailing Address - Phone:787-269-3177
Mailing Address - Fax:787-269-3177
Practice Address - Street 1:BAYAMON MEDICAL PLZ
Practice Address - Street 2:#411
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-269-3177
Practice Address - Fax:787-778-0597
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7758207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E10154Medicare UPIN