Provider Demographics
NPI:1659053387
Name:MATOS RAMOS, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MATOS RAMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE J CUPEY GARDENS
Mailing Address - Street 2:J10 CALLE 6
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:939-642-7580
Mailing Address - Fax:
Practice Address - Street 1:GRAN BLVD PASEO AVE
Practice Address - Street 2:DF-
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-283-2555
Practice Address - Fax:787-283-2545
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9258183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician