MEDICARE: ROMAN JAVIER RAMIREZ LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	105140	FL

General Provider Information

NPI Number	:	1952141194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMAN JAVIER RAMIREZ LOPEZ

Provider Business Mailing Address
First Line	:	2219 W OKALOOSA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-1029
Country	:	US
Telephone Number	:	813-409-9664
Fax Number	:

Provider Business Practice Location Address
First Line	:	2219 W OKALOOSA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-1029
Country	:	US
Telephone Number	:	813-409-9664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2024
Last Update Date	:	05/27/2024

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