Healthcare Provider Details

I. General information

NPI: 1396738134
Provider Name (Legal Business Name): JUAN MANUEL RAMIREZ M.S. R.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W ASH ST BLDG 841
MAXWELL AFB AL
36112-5954
US

IV. Provider business mailing address

331 BRIDLEBROOK BLVD
PIKE ROAD AL
36064-2776
US

V. Phone/Fax

Practice location:
  • Phone: 334-593-7117
  • Fax:
Mailing address:
  • Phone: 334-279-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: