Individual provider Active NPI

Fabiola Dels Sur Ramirez

  • Dentist
  • San Juan, PR
National Provider Identifier
1922682699
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6106151 Issued in PR
Practice address
735 Ave Ponce de Leon Ste 510
San Juan, PR 00917-5027
Phone
(787) 753-5055
NPI assigned
May 10, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Dentist 122300000X 6106151 PR Primary

Addresses

Primary practice location

735 Ave Ponce de Leon Ste 510
San Juan, PR 00917-5027

Mailing address

Carr 177 Cond Santa Maria 139
Apt 404
San Juan, PR 00926
Phone (787) 906-1397

Other practice location 1

111 E 210th St
Bronx, NY 10467-2401
Phone (718) 920-4321

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260430002500 PR Order and Referring Only - DentistPractitioner - Dentist 9133696743

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6106151PRMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1922682699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CARR 177 COND SANTA MARIA 139",
            "address_2": "APT 404",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00926",
            "telephone_number": "787-906-1397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 AVE PONCE DE LEON STE 510",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009175027",
            "telephone_number": "787-753-5055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 E 210th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104672401",
            "country_code": "US",
            "telephone_number": "718-920-4321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAMIREZ",
        "first_name": "FABIOLA",
        "middle_name": "DELS SUR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-10",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PR",
            "license": "6106151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.