Provider Demographics
NPI:1942283437
Name:RAMPOLLA BRIGANTI, FERNANDO L (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:L
Last Name:RAMPOLLA BRIGANTI
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:CALLE 1, H-1
Mailing Address - Street 2:FRAILES NORTE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:939-645-4050
Mailing Address - Fax:787-765-4806
Practice Address - Street 1:315 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3513
Practice Address - Country:US
Practice Address - Phone:787-766-3131
Practice Address - Fax:787-765-4806
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5009174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR79512Medicare ID - Type Unspecified