Basic Information
| Provider Information | |||||||||
| NPI: | 1093433930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CABRERA RAMOS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | AXEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1043 | ||||||||
| Address2: | |||||||||
| City: | CANOVANAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007291043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874077666 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4203 CALLE MARGINAL | ||||||||
| Address2: | |||||||||
| City: | FAJARDO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007383652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878601603 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2022 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 2427 | PR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.