Healthcare Provider Details

I. General information

NPI: 1740801968
Provider Name (Legal Business Name): GRISEL ARACELIN RAMOS RODRIGUEZ LCDA.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E CENTRAL AVE
WINTER HAVEN FL
33880-6312
US

IV. Provider business mailing address

217 E CENTRAL AVE
WINTER HAVEN FL
33880-6312
US

V. Phone/Fax

Practice location:
  • Phone: 407-315-3637
  • Fax: 304-358-3440
Mailing address:
  • Phone: 407-315-3637
  • Fax: 304-358-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND10122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: