1104674415 NPI number — DR. SUSSAN YLANAIRY DE LA CRUZ RAMIREZ MD

Table of content: DR. SUSSAN YLANAIRY DE LA CRUZ RAMIREZ MD (NPI 1104674415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104674415 NPI number — DR. SUSSAN YLANAIRY DE LA CRUZ RAMIREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LA CRUZ RAMIREZ
Provider First Name:
SUSSAN
Provider Middle Name:
YLANAIRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE LA CRUZ RAMIREZ
Provider Other First Name:
SUSSAN
Provider Other Middle Name:
YLANAIRY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1104674415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1370 AVE SAN IGNACIO
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:
00921-3825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-656-8821
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KM 11.7 PR-2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-656-8821
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2024

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: 390200000X , 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)





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