Provider Demographics
NPI:1730142076
Name:RICO RAMIREZ, CARMEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:M
Last Name:RICO RAMIREZ
Suffix:
Gender:F
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:PO BOX 250139
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0139
Mailing Address - Country:US
Mailing Address - Phone:787-882-6100
Mailing Address - Fax:
Practice Address - Street 1:CARR 107
Practice Address - Street 2:KM 3.3
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5970
Practice Address - Country:US
Practice Address - Phone:787-882-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15517208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22804RIOtherSSS
PR100320WOtherMMM
PR100833OtherCRUZ AZUL
PR2011266OtherPREFERRED HEALTH
PR6030142OtherHUMANA
PR2677OtherPREFERED MEDICARE CHOICE
PRA777OtherFIRST MEDICAL
PR0022804Medicare ID - Type Unspecified
PR100320WOtherMMM