Healthcare Provider Details

I. General information

NPI: 1942510482
Provider Name (Legal Business Name): JEANETTE MARYAM RAMOS-BERMUDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 07/05/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12136 COBBLE STONE DR
HUDSON FL
34667-2432
US

IV. Provider business mailing address

12136 COBBLE STONE DR
HUDSON FL
34667-2432
US

V. Phone/Fax

Practice location:
  • Phone: 727-863-5474
  • Fax:
Mailing address:
  • Phone: 727-863-5474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP7339
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18472
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME143062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: