MEDICARE: MAYELIN SAN RAMOS

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	247200000X	Other Technician		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760919294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYELIN SAN RAMOS

Provider Business Mailing Address
First Line	:	4575 SE DIXIE HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-6826
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 S MILITARY TRL LOT 30
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-2107
Country	:	US
Telephone Number	:	561-386-3369
Fax Number	:

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

Provider Enumeration Date	:	05/15/2017
Last Update Date	:	05/15/2017

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Directions to “ MAYELIN SAN RAMOS ” Practice Location

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