Provider Demographics
NPI:1245221852
Name:RAMIREZ, MARIFLOR (MT)
Entity Type:Individual
Prefix:MISS
First Name:MARIFLOR
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MT
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 985
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0985
Mailing Address - Country:US
Mailing Address - Phone:787-733-7888
Mailing Address - Fax:787-733-2475
Practice Address - Street 1:68 CALLE BARBOSA
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-3957
Practice Address - Country:US
Practice Address - Phone:787-733-7888
Practice Address - Fax:787-733-2475
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR718291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030613Medicare ID - Type Unspecified