Provider Demographics
NPI:1659322428
Name:RAMOS LEON, LIZZETTE (MD)
Entity type:Individual
Prefix:
First Name:LIZZETTE
Middle Name:
Last Name:RAMOS LEON
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:PO BOX 16117
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908
Mailing Address - Country:US
Mailing Address - Phone:787-727-1308
Mailing Address - Fax:787-727-1308
Practice Address - Street 1:MARTIN TRAVIESO ST 1500A
Practice Address - Street 2:
Practice Address - City:SANTUCE
Practice Address - State:PR
Practice Address - Zip Code:00911
Practice Address - Country:US
Practice Address - Phone:784-721-8281
Practice Address - Fax:784-721-8281
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15251208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
126549Medicare UPIN
0022921Medicare ID - Type Unspecified