Provider Demographics
NPI:1992907380
Name:ORTODONCIA DEL NOROSESTE CSP
Entity type:Organization
Organization Name:ORTODONCIA DEL NOROSESTE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-891-0993
Mailing Address - Street 1:PO BOX 4456
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4456
Mailing Address - Country:US
Mailing Address - Phone:787-891-0993
Mailing Address - Fax:787-891-7041
Practice Address - Street 1:CARR 107 KM 0 7
Practice Address - Street 2:BO BARINQUEN
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-0993
Practice Address - Fax:787-891-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
57239OtherTRIPLE S INC