Provider Demographics
NPI:1710944665
Name:ONGAY RULLAN, JOHNNY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:ONGAY RULLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 CALLE MENDEZ VIGO
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4917
Mailing Address - Country:US
Mailing Address - Phone:787-614-8905
Mailing Address - Fax:787-278-0936
Practice Address - Street 1:349 CALLE MENDEZ VIGO
Practice Address - Street 2:SUITE 10
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4917
Practice Address - Country:US
Practice Address - Phone:787-278-1062
Practice Address - Fax:787-278-0936
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11690208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88638Medicare ID - Type UnspecifiedMEDICARE NUMBER