Provider Demographics
NPI:1386854164
Name:RAMOS, ROBERTO (00979)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:RAMOS
Suffix:
Gender:M
Credentials:00979
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST.3 CONDADO MODERNO
Mailing Address - Street 2:D 20
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-517-5178
Mailing Address - Fax:
Practice Address - Street 1:#66 AGUAMARINA VILLA BLANCA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00979103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent