Healthcare Provider Details

I. General information

NPI: 1063735298
Provider Name (Legal Business Name): DIANA E RAMIREZ ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 OTTAWA DR
AUSTIN TX
78733-2673
US

IV. Provider business mailing address

1007 OTTAWA DR
AUSTIN TX
78733-2673
US

V. Phone/Fax

Practice location:
  • Phone: 512-608-1922
  • Fax:
Mailing address:
  • Phone: 512-402-0219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT4404
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: