Healthcare Provider Details

I. General information

NPI: 1083211148
Provider Name (Legal Business Name): YURISLEIDI RAMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9661 SW 17TH ST
MIAMI FL
33165-7619
US

IV. Provider business mailing address

9661 SW 17TH ST
MIAMI FL
33165-7619
US

V. Phone/Fax

Practice location:
  • Phone: 305-216-5844
  • Fax:
Mailing address:
  • Phone: 305-216-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License NumberBACB583046
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-120049
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: