Healthcare Provider Details

I. General information

NPI: 1700821451
Provider Name (Legal Business Name): OLGA AMADA RANERO GOMEZ BA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W FLAGLER ST 2ND FLOOR
MIAMI FL
33135-1619
US

IV. Provider business mailing address

11031 NE 6TH AVE
MIAMI FL
33161-7182
US

V. Phone/Fax

Practice location:
  • Phone: 305-643-8865
  • Fax: 305-643-7743
Mailing address:
  • Phone: 305-398-6100
  • Fax: 305-757-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: