Provider Demographics
NPI:1720154438
Name:RAMOS SOTO, DIOMEDES (MD)
Entity Type:Individual
Prefix:
First Name:DIOMEDES
Middle Name:
Last Name:RAMOS SOTO
Suffix:
Gender:M
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 363386
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3386
Mailing Address - Country:US
Mailing Address - Phone:787-767-3777
Mailing Address - Fax:787-720-7508
Practice Address - Street 1:1104 BLUMBAUGH & ARZUAGA ST BUILDING SANTA ANA
Practice Address - Street 2:305 OFC 3RD FLOOR
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-767-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9997208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRM1187OtherLA CHUZ AZUL DE PR
PR90292OtherTRIPLE SSS
9210120OtherHUMANA INS OF PR LENDER
5620OtherINTERNATIONAL MEDICAL CAR
9210120OtherHUMANA INS OF PR LENDER
PRM1187OtherLA CHUZ AZUL DE PR