Provider Demographics
NPI:1124005632
Name:SOLIVAN MIRANDA, RAMON A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:A
Last Name:SOLIVAN MIRANDA
Suffix:
Gender:M
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 1866
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-1866
Mailing Address - Country:US
Mailing Address - Phone:787-825-1184
Mailing Address - Fax:787-825-4381
Practice Address - Street 1:1 CALLE MARIO BRASCHI
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-2501
Practice Address - Country:US
Practice Address - Phone:787-825-1184
Practice Address - Fax:787-825-4381
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8141208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C82294Medicare UPIN