Healthcare Provider Details

I. General information

NPI: 1891322103
Provider Name (Legal Business Name): DIANA IVETTE RAMIREZ LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MIDWAY DR
EL PASO TX
79915-3850
US

IV. Provider business mailing address

734 S MESA HILLS DR APT 17
EL PASO TX
79912-5512
US

V. Phone/Fax

Practice location:
  • Phone: 915-434-7000
  • Fax:
Mailing address:
  • Phone: 915-227-3263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT1815
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: