Provider Demographics
NPI: | 1184049843 |
---|---|
Name: | LUZ N RAMOS VARGAS |
Entity type: | Organization |
Organization Name: | LUZ N RAMOS VARGAS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PSYCHOLOGY |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LUZ |
Authorized Official - Middle Name: | N |
Authorized Official - Last Name: | RAMOS VARGAS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD |
Authorized Official - Phone: | 787-688-9362 |
Mailing Address - Street 1: | RR 1 BOX 12915 |
Mailing Address - Street 2: | |
Mailing Address - City: | TOA ALTA |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00953-8639 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-688-9362 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10-5 AVE NORTH MAIN |
Practice Address - Street 2: | SIERRA BAYAMON |
Practice Address - City: | BAYAMON |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00961-4325 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-688-9362 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-03-04 |
Last Update Date: | 2014-08-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PR | 5539 | 103TC0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Single Specialty |