=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104302090
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAYRA RAMOS AGACNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2018
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1602 W BAKER RD STE 201
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521-2282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-428-4024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2219 FOLEY RD
-----------------------------------------------------
City | CROSBY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77532-7249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-629-9123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number | 321205
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 1177943
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------