Provider Demographics
NPI:1952613341
Name:RAMOS, ILEANA
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BQ4 CALLE 109
Mailing Address - Street 2:VALLE ARRIBA HEIGTHS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3318
Mailing Address - Country:US
Mailing Address - Phone:787-307-7537
Mailing Address - Fax:
Practice Address - Street 1:BQ4 CALLE 109
Practice Address - Street 2:VALLE ARRIBA HEIGTHS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3318
Practice Address - Country:US
Practice Address - Phone:787-307-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3642103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool