Provider Demographics
NPI:1841251683
Name:BALLESTEROS RAMOS, MARIA DEL CARMEN (MD)
Entity type:Individual
Prefix:
First Name:MARIA DEL CARMEN
Middle Name:
Last Name:BALLESTEROS RAMOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 EMILIO FAGOT
Mailing Address - Street 2:
Mailing Address - City:LA RANBLA
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4000
Mailing Address - Country:US
Mailing Address - Phone:787-842-1011
Mailing Address - Fax:787-848-7479
Practice Address - Street 1:SAN VICENTE 212 CONCORDIA 8169
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00713-1559
Practice Address - Country:US
Practice Address - Phone:787-259-4312
Practice Address - Fax:787-848-7479
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10009207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0082267Medicare ID - Type Unspecified
E62725Medicare UPIN