Healthcare Provider Details

I. General information

NPI: 1750001244
Provider Name (Legal Business Name): MILAGROS RAMIREZ BA IN PSYCHOLOGY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3763 EVANS AVE
FORT MYERS FL
33901-9302
US

IV. Provider business mailing address

3763 EVANS AVE
FORT MYERS FL
33901-9302
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-3222
  • Fax: 239-332-0287
Mailing address:
  • Phone: 239-275-3222
  • Fax: 239-332-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberR562-540-97-882-1
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: