Healthcare Provider Details

I. General information

NPI: 1558894535
Provider Name (Legal Business Name): BRANDON MAISEL RAMOS D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 07/16/2023
Certification Date: 07/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 CENTRAL PARK BLVD N STE 222
BOCA RATON FL
33428-1704
US

IV. Provider business mailing address

9980 CENTRAL PARK BLVD N STE 222
BOCA RATON FL
33428-1704
US

V. Phone/Fax

Practice location:
  • Phone: 561-558-8898
  • Fax:
Mailing address:
  • Phone: 561-558-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS18961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: