Provider Demographics
NPI:1356328736
Name:COUTO-SEPULVEDA, JOSE RAMON (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:RAMON
Last Name:COUTO-SEPULVEDA
Suffix:
Gender:M
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 7294
Mailing Address - Street 2:863 CAMPECHE ST
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7294
Mailing Address - Country:US
Mailing Address - Phone:787-840-2125
Mailing Address - Fax:787-840-2435
Practice Address - Street 1:863 CAMPECHE ST
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-840-2125
Practice Address - Fax:787-840-2435
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6038207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
97571Medicare ID - Type Unspecified
C84212Medicare UPIN