Provider Demographics
NPI:1033303243
Name:RAMIREZ, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 NW 128TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2319
Mailing Address - Country:US
Mailing Address - Phone:347-326-1776
Mailing Address - Fax:
Practice Address - Street 1:15715 S DIXIE HWY
Practice Address - Street 2:SUITE 218
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1800
Practice Address - Country:US
Practice Address - Phone:347-326-1776
Practice Address - Fax:877-977-4957
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021430-1235Z00000X
FLSA11218235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ933136OtherAHCCS
FL008813000Medicaid