Healthcare Provider Details

I. General information

NPI: 1376851006
Provider Name (Legal Business Name): MAYRA RIPOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 MICHIGAN AVE
KISSIMMEE FL
34744-1936
US

IV. Provider business mailing address

14536 GATEWAY POINTE CIR APT 9207
ORLANDO FL
32821-5144
US

V. Phone/Fax

Practice location:
  • Phone: 440-740-7840
  • Fax:
Mailing address:
  • Phone: 939-645-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8238
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: