Provider Demographics
NPI:1104608637
Name:RAMOS ORTIZ, BRUNO JASET
Entity type:Individual
Prefix:
First Name:BRUNO
Middle Name:JASET
Last Name:RAMOS ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9132 SUN TERRACE CIR APT A
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-4106
Mailing Address - Country:US
Mailing Address - Phone:787-515-5059
Mailing Address - Fax:
Practice Address - Street 1:11501 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6507
Practice Address - Country:US
Practice Address - Phone:561-805-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46028390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program