=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205343571
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDAILYN RAMIREZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2018
-----------------------------------------------------
Last Update Date | 12/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 756 W PALM DR
-----------------------------------------------------
City | FLORIDA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33034-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-246-2530
-----------------------------------------------------
Fax | 305-246-4585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 756 W PALM DR
-----------------------------------------------------
City | FLORIDA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33034-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-246-3530
-----------------------------------------------------
Fax | 305-246-4585
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 247200000X
-----------------------------------------------------
Taxonomy Name | Other Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------