MEDICARE: LYDIA IRIS RAMIREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00020875	WA

General Provider Information

NPI Number	:	1275778391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA IRIS RAMIREZ

Provider Business Mailing Address
First Line	:	404 91ST AVE NE STE B
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-2567
Country	:	US
Telephone Number	:	206-240-7517
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 91ST AVE NE STE B
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-2567
Country	:	US
Telephone Number	:	206-240-7517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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Directions to “ LYDIA IRIS RAMIREZ ” Practice Location

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