Healthcare Provider Details

I. General information

NPI: 1063423713
Provider Name (Legal Business Name): HECTOR RAMOS MENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E NEW YORK AVE
DELAND FL
32724-5413
US

IV. Provider business mailing address

214 E NEW YORK AVE
DELAND FL
32724-5413
US

V. Phone/Fax

Practice location:
  • Phone: 386-279-7533
  • Fax: 386-279-7533
Mailing address:
  • Phone: 386-279-7533
  • Fax: 386-279-7533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10745
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: