Healthcare Provider Details

I. General information

NPI: 1649844267
Provider Name (Legal Business Name): LEONARDO RAUL RAMIREZ BOTANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TAMIAMI TRL STE 101A
PORT CHARLOTTE FL
33952-8054
US

IV. Provider business mailing address

3300 TAMIAMI TRL STE 101A
PORT CHARLOTTE FL
33952-8054
US

V. Phone/Fax

Practice location:
  • Phone: 772-626-8754
  • Fax:
Mailing address:
  • Phone: 941-629-4676
  • Fax: 941-629-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME180159
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15521-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: