Provider Demographics
NPI:1619647732
Name:ELIAS, AUGUSTO RAMON
Entity Type:Individual
Prefix:DR
First Name:AUGUSTO
Middle Name:RAMON
Last Name:ELIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 CALLE ORQUIDEA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6715
Mailing Address - Country:US
Mailing Address - Phone:787-554-0559
Mailing Address - Fax:
Practice Address - Street 1:1928 CALLE ORQUIDEA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6715
Practice Address - Country:US
Practice Address - Phone:787-554-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8121744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study