1609971423 NPI number — DR. GUSTAVO ADOLFO GARCIA RAMOS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609971423 NPI number — DR. GUSTAVO ADOLFO GARCIA RAMOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA RAMOS
Provider First Name:
GUSTAVO
Provider Middle Name:
ADOLFO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARCIA RAMOS
Provider Other First Name:
GUSTAVO
Provider Other Middle Name:
ADOLFO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609971423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1804 WHITEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAREDO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-795-0760
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6551 STAR CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAREDO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-523-7850
Provider Business Practice Location Address Fax Number:
956-523-7851
Provider Enumeration Date:
09/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  K5946 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P000141G1 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".