1295805505 NPI number — DR. FRANCISCO PORTILLO RAMOS D.D.S.

Table of content: DR. FRANCISCO PORTILLO RAMOS D.D.S. (NPI 1295805505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295805505 NPI number — DR. FRANCISCO PORTILLO RAMOS D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMOS
Provider First Name:
FRANCISCO
Provider Middle Name:
PORTILLO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
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:
1295805505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11230 WEST AVE
Provider Second Line Business Mailing Address:
STE. 3205
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78213-1350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-524-9866
Provider Business Mailing Address Fax Number:
210-497-2599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11230 WEST AVE
Provider Second Line Business Practice Location Address:
STE. 3205
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78213-1350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-524-9866
Provider Business Practice Location Address Fax Number:
210-497-2599
Provider Enumeration Date:
11/08/2006

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: 1223G0001X , with the licence number:  16870 , 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: 793997 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 126740302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: B167801 . This is a "TEXAS CHIP DENTAL SERVICE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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