Provider Demographics
NPI:1306479647
Name:RAMOS QUINTANA, IDALIS (PSYCHOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:IDALIS
Middle Name:
Last Name:RAMOS QUINTANA
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:IDALIS
Other - Middle Name:
Other - Last Name:RAMOS QUINTANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:HC 5 BOX 53385
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-5856
Mailing Address - Country:US
Mailing Address - Phone:939-419-9504
Mailing Address - Fax:
Practice Address - Street 1:AVE. ARCADIO ESTRADA 4160
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-0000
Practice Address - Country:US
Practice Address - Phone:787-908-0908
Practice Address - Fax:787-777-1591
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006269103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty