Healthcare Provider Details

I. General information

NPI: 1033724620
Provider Name (Legal Business Name): ROMEL CAUDALES RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

45 NW 46TH AVE
MIAMI FL
33126-5359
US

IV. Provider business mailing address

45 NW 46TH AVE
MIAMI FL
33126-5359
US

V. Phone/Fax

Practice location:
  • Phone: 786-262-1024
  • Fax:
Mailing address:
  • Phone: 786-262-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07202327
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: