Provider Demographics
NPI:1528095262
Name:MOURELO, RAMON SABASTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:SABASTIAN
Last Name:MOURELO
Suffix:
Gender:M
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:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:
Practice Address - Street 1:1281 E COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2949
Practice Address - Country:US
Practice Address - Phone:520-876-0416
Practice Address - Fax:520-421-3474
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 35546174400000X
AZ35546208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115874Medicaid
AZ5058816OtherCIGNA
FLP01342438OtherRR MEDICARE
AZ35546OtherARIZONA MEDICAL BOARD
AZ35546OtherARIZONA MEDICAL BOARD
AZZ166865Medicare PIN