1063937456 NPI number — DR. JUAN SEBASTIAN RAMOS VELA MD

Table of content: DR. JUAN SEBASTIAN RAMOS VELA MD (NPI 1063937456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063937456 NPI number — DR. JUAN SEBASTIAN RAMOS VELA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMOS VELA
Provider First Name:
JUAN
Provider Middle Name:
SEBASTIAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063937456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 E RIVER DR
Provider Second Line Business Mailing Address:
5TH FLOOR
Provider Business Mailing Address City Name:
EAST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06108-7301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-929-7353
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 SEYMOUR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06102-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-929-7375
Provider Business Practice Location Address Fax Number:
860-929-0756
Provider Enumeration Date:
08/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 69679 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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