Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 21502 | PR |
NPI | 1023661444 |
---|---|
Provider Name | Jose J Perez Ramos |
First Address | Jayuya, PR 00664-1453 |
Second Address | Juana Diaz, PR 00795-1613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2019 |
Last Update Date | 24/07/2019 |