Provider Demographics
NPI:1346488897
Name:FUENTES RAMOS, CARMEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:D
Last Name:FUENTES 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:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0254
Mailing Address - Country:US
Mailing Address - Phone:787-597-1934
Mailing Address - Fax:
Practice Address - Street 1:URB JARDINES DE MAVILLA CASA 2
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-0254
Practice Address - Country:US
Practice Address - Phone:787-597-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17412208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice