Provider Demographics
NPI:1063014132
Name:RAMOS GUETTE, MIRYAM MERCEDES
Entity Type:Individual
Prefix:
First Name:MIRYAM
Middle Name:MERCEDES
Last Name:RAMOS GUETTE
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 1:429 COCONUT ISLE DR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2425
Mailing Address - Country:US
Mailing Address - Phone:786-973-1574
Mailing Address - Fax:
Practice Address - Street 1:790 E BROWARD BLVD APT 314
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2898
Practice Address - Country:US
Practice Address - Phone:786-973-1574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist