Provider Demographics
NPI:1982692075
Name:RAMOS OLIVENCIA, LILLIAM MABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LILLIAM
Middle Name:MABEL
Last Name:RAMOS OLIVENCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2225 PONCE BY PASS
Mailing Address - Street 2:SUITE 501
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1368
Mailing Address - Country:US
Mailing Address - Phone:787-843-9110
Mailing Address - Fax:787-259-2195
Practice Address - Street 1:2225 PONCE BY PASS
Practice Address - Street 2:SUITE 501
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1321
Practice Address - Country:US
Practice Address - Phone:787-843-9110
Practice Address - Fax:787-259-2195
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8304208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081693-ROMedicare ID - Type Unspecified
PRF08075Medicare UPIN