Provider Demographics
NPI:1679629398
Name:RAMOS PEREIRA, RAUL L
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:L
Last Name:RAMOS PEREIRA
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 1:1717 AVE PONCE DE LEON
Mailing Address - Street 2:APT 2204
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1924
Mailing Address - Country:US
Mailing Address - Phone:787-728-3330
Mailing Address - Fax:
Practice Address - Street 1:RYDER MEMORIAL HOSPITAL
Practice Address - Street 2:355 AVE FONT MARTELO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-852-0768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7668208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC78265Medicare UPIN
PR99092Medicare ID - Type Unspecified