1720154438 NPI number — DIOMEDES RAMOS SOTO MD

Table of content: DIOMEDES RAMOS SOTO MD (NPI 1720154438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720154438 NPI number — DIOMEDES RAMOS SOTO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMOS SOTO
Provider First Name:
DIOMEDES
Provider Middle Name:
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720154438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 363386
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-3386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-767-3777
Provider Business Mailing Address Fax Number:
787-720-7508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1104 BLUMBAUGH & ARZUAGA ST BUILDING SANTA ANA
Provider Second Line Business Practice Location Address:
305 OFC 3RD FLOOR
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-767-3777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2006

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: 208D00000X , with the licence number:  9997 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: M1187 . This is a "LA CHUZ AZUL DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 90292 . This is a "TRIPLE SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9210120 . This is a "HUMANA INS OF PR LENDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5620 . This is a "INTERNATIONAL MEDICAL CAR" identifier . This identifiers is of the category "OTHER".