Provider Demographics
NPI:1093448631
Name:RAMIREZ RODRIGUEZ, JUAN CARLOS JUNIOR
Entity Type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:JUNIOR
Last Name:RAMIREZ RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB PALACIOS DEL PRADO CALLE GOLFO DE MEXICO #99
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-598-7423
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL PSIQUIATRICO FORENSES AVE. TITO CASTRO
Practice Address - Street 2:BO MACHUELO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-598-7423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR141691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical