Provider Demographics
NPI:1669815908
Name:RAMOS, JOSE VIDAL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:VIDAL
Last Name:RAMOS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXTENSION FOREST HILLS, MADRID L414
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5706
Mailing Address - Country:US
Mailing Address - Phone:787-380-9488
Mailing Address - Fax:
Practice Address - Street 1:610 AVE. COMERIO MARGINAL
Practice Address - Street 2:DENTRO SUPERMERCADO ECONO LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical