Provider Demographics
NPI:1023514320
Name:RAMOS-ROSA, FERNANDO RAFAEL
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:RAFAEL
Last Name:RAMOS-ROSA
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:PO BOX 14444
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00916-4444
Mailing Address - Country:US
Mailing Address - Phone:787-710-4400
Mailing Address - Fax:
Practice Address - Street 1:313 CALLE MANUEL DOMENECH STE 203
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3532
Practice Address - Country:US
Practice Address - Phone:787-710-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4298103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling