Provider Demographics
NPI:1720662265
Name:RIVERA RAMOS, ILEANA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:MARIA
Last Name:RIVERA RAMOS
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:URB.CHALETS DE BAIROA, 101 CALLE COLIBRI
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-1273
Mailing Address - Country:US
Mailing Address - Phone:787-225-3666
Mailing Address - Fax:
Practice Address - Street 1:URB.CHALETS DE BAIROA, 101 CALLE COLIBRI
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1273
Practice Address - Country:US
Practice Address - Phone:787-225-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22434208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice