Basic Information
| Provider Information | |||||||||
| NPI: | 1306806757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMARAL RAMOS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | M | ||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AMARAL RAMOS | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | MD, PA | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 61160 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784661160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3614422442 | ||||||||
| FaxNumber: | 3618841912 | ||||||||
| Practice Location | |||||||||
| Address1: | 5920 SARATOGA BLVD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784144106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3614422442 | ||||||||
| FaxNumber: | 3613566101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | M1004 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | 207RE0101X | M1004 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 175651206 | 05 | TX | MEDICAID |