Healthcare Provider Details

I. General information

NPI: 1770623795
Provider Name (Legal Business Name): MAYRA LIZETTE RAMIREZ LND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. CAMPO RICO A-6 CASTELLANA GARDENS
CAROLINA PR
00983
US

IV. Provider business mailing address

578 CALLE CANEY
TOA ALTA PR
00953-3854
US

V. Phone/Fax

Practice location:
  • Phone: 787-752-7897
  • Fax: 787-768-0689
Mailing address:
  • Phone: 787-501-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1463
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: