Provider Demographics
NPI:1376752519
Name:RAMOS, MELBA (RPT)
Entity Type:Individual
Prefix:
First Name:MELBA
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 325
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3418
Mailing Address - Country:US
Mailing Address - Phone:787-754-0725
Mailing Address - Fax:787-622-3490
Practice Address - Street 1:431 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 325
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3418
Practice Address - Country:US
Practice Address - Phone:787-754-0725
Practice Address - Fax:787-622-3490
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ-65597Medicare UPIN