1043848963 NPI number — BRENDA NATHALI RAMIREZ MD

Table of content: BRENDA NATHALI RAMIREZ MD (NPI 1043848963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043848963 NPI number — BRENDA NATHALI RAMIREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMIREZ
Provider First Name:
BRENDA
Provider Middle Name:
NATHALI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1043848963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14690 SPRING HILL DR STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34609-8102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-799-0046
Provider Business Mailing Address Fax Number:
352-799-0042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 LAMSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING HILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34608-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-691-5070
Provider Business Practice Location Address Fax Number:
352-691-5075
Provider Enumeration Date:
03/27/2020

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: 207R00000X , with the licence number: ME160534 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 120080400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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