Healthcare Provider Details

I. General information

NPI: 1750851689
Provider Name (Legal Business Name): MYRA CLEOTILDE RED RAMOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2537 AMATI DR
KISSIMMEE FL
34741-7703
US

IV. Provider business mailing address

2537 AMATI DR
KISSIMMEE FL
34741-7703
US

V. Phone/Fax

Practice location:
  • Phone: 407-780-6893
  • Fax:
Mailing address:
  • Phone: 407-780-6893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9383027
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: