Provider Demographics
NPI:1972655447
Name:RAMIREZ, EDRICK N
Entity Type:Individual
Prefix:DR
First Name:EDRICK
Middle Name:N
Last Name:RAMIREZ
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:URBANIZACION COSTA NORTE
Mailing Address - Street 2:K 14
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-612-8094
Mailing Address - Fax:787-895-6315
Practice Address - Street 1:CARR # 2 KM 64.29 # 48 PMB
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-612-8094
Practice Address - Fax:787-895-6315
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21304Medicare ID - Type Unspecified
PRH79743Medicare UPIN