Provider Demographics
NPI:1881947711
Name:OLMOS, RONNY G (SW)
Entity type:Individual
Prefix:
First Name:RONNY
Middle Name:G
Last Name:OLMOS
Suffix:
Gender:M
Credentials:SW
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 30616
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-1616
Mailing Address - Country:US
Mailing Address - Phone:787-768-0591
Mailing Address - Fax:
Practice Address - Street 1:JARDINES DE BERWIND
Practice Address - Street 2:EDF.O APT.163
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-768-0591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16537104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker