Provider Demographics
NPI:1689888133
Name:RAMOS, ODILY (MA)
Entity Type:Individual
Prefix:
First Name:ODILY
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAS CUMBRES #497, EMILIANO POL ST.
Mailing Address - Street 2:PMB-383
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5636
Mailing Address - Country:US
Mailing Address - Phone:939-389-0327
Mailing Address - Fax:787-767-7806
Practice Address - Street 1:GUARIONEX ST. #7
Practice Address - Street 2:LOCAL # 2
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-767-7695
Practice Address - Fax:787-767-7806
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2587103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2587OtherPROFESSIONAL LICENCE