Provider Demographics
NPI:1083760821
Name:RAMOS BELEN, JOHANNA GRISELL (OD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:GRISELL
Last Name:RAMOS BELEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CORAL 53
Mailing Address - Street 2:REPTO PUEBLO NUEVO
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-410-5774
Mailing Address - Fax:787-833-9200
Practice Address - Street 1:53 CALLE CORAL
Practice Address - Street 2:REPTO PUEBLO NUEVO
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4306
Practice Address - Country:US
Practice Address - Phone:787-410-5774
Practice Address - Fax:787-833-9200
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2170311OtherDRIVER LISCENSE