Provider Demographics
NPI:1023022357
Name:RAMIREZ, CARMEN TERESA (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:TERESA
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 515
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2219
Mailing Address - Country:US
Mailing Address - Phone:813-956-2332
Mailing Address - Fax:
Practice Address - Street 1:2021 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 515
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2219
Practice Address - Country:US
Practice Address - Phone:813-956-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME845812084N0400X
TXP75472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL231965OtherWELLCARE
FL47902OtherBLUE CROSS BLUE SHIELD
FL7029399OtherAETNA
TX8BR228OtherBLUE CROSS BLUE SHIELD OF TEXAS
FL283545OtherAVMED
FLP00141857OtherRAILROAD MEDICARE
FL2130547OtherFIRST HEALTH
TX2016123-02Medicaid
FL264315400Medicaid
FL47902AMedicare PIN
TX2016123-02Medicaid
FL7029399OtherAETNA
FL2130547OtherFIRST HEALTH
FL264315400Medicaid