Provider Demographics
NPI:1154329605
Name:RAMOS, WANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:
Last Name:RAMOS
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:PMB #146
Mailing Address - Street 2:5900 ISLA VERDE AVE STE 2
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-5746
Mailing Address - Country:US
Mailing Address - Phone:787-722-0445
Mailing Address - Fax:787-723-4415
Practice Address - Street 1:359 AVE DE DIEGO 501
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-1740
Practice Address - Country:US
Practice Address - Phone:787-722-0445
Practice Address - Fax:787-723-4415
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G40958Medicare UPIN
8-4624Medicare ID - Type Unspecified