Provider Demographics
NPI:1245280270
Name:GERENA RAMIREZ, GRISELLE (MD)
Entity type:Individual
Prefix:
First Name:GRISELLE
Middle Name:
Last Name:GERENA RAMIREZ
Suffix:
Gender:F
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 LUIS MUNOZ RIVERA # 159 B
Mailing Address - Street 2:CALLE LUIS MUNOZ RIVERA # 159 B
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-0000
Mailing Address - Country:US
Mailing Address - Phone:787-736-9660
Mailing Address - Fax:787-937-7883
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA 159
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-9660
Practice Address - Fax:787-937-7883
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15198208D00000X
PR15.198208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15.198Medicaid
0023580Medicare ID - Type Unspecified