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General NPI Number Information
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NPI Number | 1467001677
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Entity Type | Individual
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Provider Name | DIEGO RAMIREZ ATC, LAT, LMT.
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Gender | Male
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 538 MARKLEN LOOP
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City | POLK CITY
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State | FL
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Zip | 33868-9600
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Country | US
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Telephone | 828-789-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 538 MARKLEN LOOP
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City | POLK CITY
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State | FL
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Zip | 33868-9600
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL5172
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License Number State | FL
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