Basic Information
| Provider Information | |||||||||
| NPI: | 1891159992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMIREZ | ||||||||
| FirstName: | CRISTIAN | ||||||||
| MiddleName: | A | ||||||||
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| OtherLastName: | RAMIREZ | ||||||||
| OtherFirstName: | CRYSTIAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 17 DAVIS BLVD | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132502506 | ||||||||
| FaxNumber: | 8132502547 | ||||||||
| Practice Location | |||||||||
| Address1: | 17 DAVIS BLVD | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132502111 | ||||||||
| FaxNumber: | 8132502547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2016 | ||||||||
| LastUpdateDate: | 04/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.