Basic Information
| Provider Information | |||||||||
| NPI: | 1740636026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANALES RAMOS | ||||||||
| FirstName: | NICOLLE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY DISTRICT HOSPITAL | ||||||||
| Address2: | PUERTO RICO MEDICAL CENTER BO. MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY DISTRICT HOSPITAL | ||||||||
| Address2: | PUERTO RICO MEDICAL CENTER BO. MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2016 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34153 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 22100 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.