Healthcare Provider Details

I. General information

NPI: 1588628135
Provider Name (Legal Business Name): JASMIN GRACE VALERA RAMIREZ RD LD CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JASMIN GRACE PAGUYO VALERA RD LD

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 YORK AVE S SUITE 180
EDINA MN
55435-5845
US

IV. Provider business mailing address

7701 YORK AVE S SUITE 180
EDINA MN
55435-5845
US

V. Phone/Fax

Practice location:
  • Phone: 952-927-7810
  • Fax: 952-927-6309
Mailing address:
  • Phone: 952-927-7810
  • Fax: 952-927-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number2364
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: