Healthcare Provider Details

I. General information

NPI: 1396883534
Provider Name (Legal Business Name): RAMIRO NMN DAZA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 POINTE WEST DR STE 102
VERO BEACH FL
32966-1308
US

IV. Provider business mailing address

1960 POINTE WEST DR STE 102
VERO BEACH FL
32966-1308
US

V. Phone/Fax

Practice location:
  • Phone: 772-226-4253
  • Fax: 772-226-4253
Mailing address:
  • Phone: 772-226-4250
  • Fax: 772-226-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME130073
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME130073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: