Basic Information
| Provider Information | |||||||||
| NPI: | 1851332415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMOS | ||||||||
| FirstName: | LINO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7113 SAN PEDRO AVE | ||||||||
| Address2: | # 316 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782166219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107450084 | ||||||||
| FaxNumber: | 2107450139 | ||||||||
| Practice Location | |||||||||
| Address1: | 7330 SAN PEDRO | ||||||||
| Address2: | STE. 405 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782166235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103442673 | ||||||||
| FaxNumber: | 2103442649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35063998R | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208M00000X | M5458 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | M5458 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 942460636110 | 01 | OH | CARESOURCE | OTHER | 110188205 | 01 | OH | MEDICARE RR-GA | OTHER |