Provider Demographics
NPI:1851375588
Name:RAMON ANTONIO SOLIVAN MIRANDA
Entity type:Organization
Organization Name:RAMON ANTONIO SOLIVAN MIRANDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-825-1184
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:1 MARIO BRASCHI ST
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-1866
Mailing Address - Country:US
Mailing Address - Phone:787-825-1184
Mailing Address - Fax:787-825-1184
Practice Address - Street 1:1 CALLE MARIO BRASCHI
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-2501
Practice Address - Country:US
Practice Address - Phone:787-825-1184
Practice Address - Fax:787-825-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR271291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38276Medicare PIN