Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15701-I | PR |
NPI | 1003492497 |
---|---|
Provider Name | Dr. Jean C De Los Santos Ramos |
First Address | Dorado, PR 00646 |
Second Address | Bayamon, PR 00959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2021 |
Last Update Date | 24/03/2021 |