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NPI Code Detail

MEDICARE: CHILD AND ADOLESCENT TAMPA BAY PSYCHIATRY, LLC

MEDICARE: CHILD AND ADOLESCENT TAMPA BAY PSYCHIATRY, LLC
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
12084P0804XChild & Adolescent Psychiatry PhysicianME112720FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
212662244OTHERCAQH
31669639001OTHERINDIVIDUAL NPI
42084P0800XOTHERINDIVIDUAL TAXONOMY
5ME112720OTHERFLLICENSE NUMBER

General Provider Information

NPI Number : 1952829137
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILD AND ADOLESCENT TAMPA BAY PSYCHIATRY, LLC
Provider Business Mailing Address
First Line : 12231 MAIN ST UNIT 1196
Second Line :
City : SAN ANTONIO
State : FL
Zip : 33576-7253
Country : US
Telephone Number : 813-440-2741
Fax Number : 813-338-4490
Provider Business Practice Location Address
First Line : 100 S ASHLEY DR STE 600
Second Line :
City : TAMPA
State : FL
Zip : 33602-5300
Country : US
Telephone Number : 813-766-4218
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : DR. ONELIA RAMIREZ-COOK
Credential : MD
Telephone Number : 813-766-4218
Provider Enumeration Date : 09/07/2017
Last Update Date : 09/07/2017

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