Provider Demographics
NPI:1922682699
Name:RAMIREZ, FABIOLA DELS SUR
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:DELS SUR
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 177 COND SANTA MARIA 139
Mailing Address - Street 2:APT 404
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-906-1397
Mailing Address - Fax:
Practice Address - Street 1:735 AVE PONCE DE LEON STE 510
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5027
Practice Address - Country:US
Practice Address - Phone:787-753-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR6106151122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program