Healthcare Provider Details

I. General information

NPI: 1679772354
Provider Name (Legal Business Name): CELIA RAMIREZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10971 CRABAPPLE RD STE 1900
ROSWELL GA
30075-5836
US

IV. Provider business mailing address

4967 SW 90TH WAY
COOPER CITY FL
33328-3501
US

V. Phone/Fax

Practice location:
  • Phone: 678-535-0090
  • Fax: 678-535-0092
Mailing address:
  • Phone: 954-512-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10956
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9104986
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number011901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: