Healthcare Provider Details

I. General information

NPI: 1134057961
Provider Name (Legal Business Name): MYDOLLY MARIA RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 GABLE ST
BOCA RATON FL
33428-4017
US

IV. Provider business mailing address

10921 GABLE ST
BOCA RATON FL
33428-4017
US

V. Phone/Fax

Practice location:
  • Phone: 305-790-3814
  • Fax: 305-790-3814
Mailing address:
  • Phone: 305-790-3814
  • Fax: 305-790-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-499031
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1093449993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: