Provider Demographics
NPI:1346447679
Name:CARBONELL RAMIREZ, RAMON
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:CARBONELL RAMIREZ
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:A24 CALLE MANUELA WALKER
Mailing Address - Street 2:ROLLING HILL
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7002
Mailing Address - Country:US
Mailing Address - Phone:787-638-1077
Mailing Address - Fax:
Practice Address - Street 1:CALLE CANALIZA 1423
Practice Address - Street 2:AVE DE DIEGO
Practice Address - City:PUERTO NUEVO
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-783-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility