Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2819 | PR |
NPI | 1245436849 |
---|---|
Provider Name | Viola Ramos Jordan |
First Address | San Juan, PR 00918-3901 |
Second Address | San Juan, PR 00918-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2819 | MEDICAL LICENCE (01) | PR |