Provider Demographics
NPI:1851412910
Name:RAMOS, MARIO ANTONIO
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ANTONIO
Last Name:RAMOS
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 1:3 CALLE AMATISTA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7046
Mailing Address - Country:US
Mailing Address - Phone:787-599-9968
Mailing Address - Fax:
Practice Address - Street 1:369 AVE. DE DIEGO, TORRE SAN FRANCISCO
Practice Address - Street 2:SUITE 307
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3005
Practice Address - Country:US
Practice Address - Phone:787-756-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11628207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41812Medicare UPIN
PR88468Medicare ID - Type Unspecified