Healthcare Provider Details

I. General information

NPI: 1932755840
Provider Name (Legal Business Name): NOHEMI AZUCENA RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N. CARLISLE AVE.
SOMERTON AZ
85350
US

IV. Provider business mailing address

PO BOX 13335
SAN LUIS AZ
85349-6909
US

V. Phone/Fax

Practice location:
  • Phone: 928-341-6042
  • Fax: 928-341-6099
Mailing address:
  • Phone: 928-580-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA11632
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: