Provider Demographics
NPI:1801894746
Name:PAOLI-BRUNO, RAMON NICOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:NICOLAS
Last Name:PAOLI-BRUNO
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 194288
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4288
Mailing Address - Country:US
Mailing Address - Phone:787-607-0793
Mailing Address - Fax:787-755-9005
Practice Address - Street 1:51 CALLE FLOR GERENA S
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4207
Practice Address - Country:US
Practice Address - Phone:787-607-0793
Practice Address - Fax:787-755-9005
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2010-01-28
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
PR7355207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD-08479Medicare UPIN
PR0028846Medicare PIN