Provider Demographics
NPI:1174667505
Name:RAMOS, LUIS RODOLFO (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:RODOLFO
Last Name:RAMOS
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
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 683
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0683
Mailing Address - Country:US
Mailing Address - Phone:787-269-2046
Mailing Address - Fax:787-269-2046
Practice Address - Street 1:A14 AVE LOMAS VERDES
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3134
Practice Address - Country:US
Practice Address - Phone:787-269-2046
Practice Address - Fax:787-269-2046
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001822103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ01907Medicare UPIN
PR5-6628Medicare ID - Type UnspecifiedPSYCHOLOGY