Provider Demographics
NPI:1265063572
Name:RAMOS, EMILISSE FRANCHESKA (LND)
Entity type:Individual
Prefix:
First Name:EMILISSE
Middle Name:FRANCHESKA
Last Name:RAMOS
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LOS DOMINICOS
Mailing Address - Street 2:CALLE SAN AGUSTIN B43
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-585-6669
Mailing Address - Fax:
Practice Address - Street 1:KM 13., 3 CALLE 4
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-993-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2122133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038141501Medicaid
PR1265063572OtherNPI