Provider Demographics
NPI:1902358617
Name:ORTIZ-RAMOS, SHAIRA E (LND)
Entity Type:Individual
Prefix:
First Name:SHAIRA
Middle Name:E
Last Name:ORTIZ-RAMOS
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B1 CALLE SAN MATEO
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-5406
Mailing Address - Country:US
Mailing Address - Phone:787-597-7086
Mailing Address - Fax:
Practice Address - Street 1:B1 CALLE SAN MATEO
Practice Address - Street 2:URB SAN PEDRO
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-597-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1865133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0010112Medicare UPIN