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General NPI Number Information
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NPI Number | 1508682071
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Entity Type | Individual
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Provider Name | DISSIRAMA A BETIMBENA SOLE MBR
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Gender |
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Dates
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Enumeration Date | 11/29/2024
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 11260 CHESTER RD FL 7
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City | CINCINNATI
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State | OH
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Zip | 45246-4048
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Country | US
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Telephone | 513-747-0460
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Fax |
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Provider Business Mailing Address
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Address Line | 11260 CHESTER RD FL 7
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City | CINCINNATI
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State | OH
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Zip | 45246-4048
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Country | US
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Telephone | 513-747-0460
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Fax | 513-747-0460
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 29BYIDRXDQ
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 335E00000X
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License Number State | OH
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