Healthcare Provider Details

I. General information

NPI: 1942886742
Provider Name (Legal Business Name): JOHN RALPH REMY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 FERGUSON DR STE 200
ORLANDO FL
32805-1023
US

IV. Provider business mailing address

7547 PARK PROMENADE DR APT 1518
WINTER PARK FL
32792-8627
US

V. Phone/Fax

Practice location:
  • Phone: 831-204-7854
  • Fax: 407-965-4480
Mailing address:
  • Phone: 407-860-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: