Provider Demographics
NPI:1518096056
Name:VIZCARRONDO, RAMON A (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:A
Last Name:VIZCARRONDO
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 1258
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-1258
Mailing Address - Country:US
Mailing Address - Phone:787-752-6089
Mailing Address - Fax:787-752-6089
Practice Address - Street 1:CALLE IGNACIO ARZUAGA #5-E
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-752-6089
Practice Address - Fax:787-752-6089
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5376OtherLICENSE NUMBER IN PR
PR5376OtherLICENSE NUMBER IN PR
PR26576Medicare ID - Type UnspecifiedPROVIDER NUMBER
PR5376OtherLICENSE NUMBER IN PR