Healthcare Provider Details

I. General information

NPI: 1992052351
Provider Name (Legal Business Name): CORAZON LAZARO RAMOS RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2012
Last Update Date: 08/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ORANGE AVE SUITE 123
LIVINGSTON NJ
07039-5817
US

IV. Provider business mailing address

200 S ORANGE AVE SUITE 123
LIVINGSTON NJ
07039-5817
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-7265
  • Fax: 973-322-7254
Mailing address:
  • Phone: 973-322-7265
  • Fax: 973-322-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NO08345700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: