Healthcare Provider Details

I. General information

NPI: 1669366522
Provider Name (Legal Business Name): ROSARIO RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 W JEFFERSON BLVD
DALLAS TX
75208-4924
US

IV. Provider business mailing address

1616 HEATHER GLEN DR
DALLAS TX
75232-2424
US

V. Phone/Fax

Practice location:
  • Phone: 217-498-2989
  • Fax:
Mailing address:
  • Phone: 214-815-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number928761
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1202763
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1202763
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: