Provider Demographics
NPI:1386712552
Name:PANDO, JOSE RAMON (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAMON
Last Name:PANDO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:26 CARR 833
Mailing Address - Street 2:107-A
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9001
Mailing Address - Country:US
Mailing Address - Phone:787-708-9556
Mailing Address - Fax:787-708-9537
Practice Address - Street 1:100 PASEO SAN PABLO
Practice Address - Street 2:509
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7019
Practice Address - Country:US
Practice Address - Phone:787-269-0860
Practice Address - Fax:787-269-0872
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR000004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89200Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRS43739Medicare UPIN