Healthcare Provider Details

I. General information

NPI: 1164275707
Provider Name (Legal Business Name): DESTINY LEE RAMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 TANGLEWOOD DR
OTTAWA OH
45875-1064
US

IV. Provider business mailing address

404 N KEYSER ST
HOLGATE OH
43527-9719
US

V. Phone/Fax

Practice location:
  • Phone: 419-796-0306
  • Fax:
Mailing address:
  • Phone: 567-376-7269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: