Provider Demographics
NPI:1770931321
Name:ESPADA GONZALEZ, RAMON E (MASTER)
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:E
Last Name:ESPADA GONZALEZ
Suffix:
Gender:M
Credentials:MASTER
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 361238
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-1238
Mailing Address - Country:US
Mailing Address - Phone:787-477-1481
Mailing Address - Fax:
Practice Address - Street 1:100 AVE. NORFRE
Practice Address - Street 2:TERRAZAS MONTE CASINO APT. 703
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-477-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR199751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical