Provider Demographics
NPI:1104384833
Name:RAMOS LOE, TRYSTIN
Entity Type:Individual
Prefix:
First Name:TRYSTIN
Middle Name:
Last Name:RAMOS LOE
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 1:1223 GOLDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2837
Mailing Address - Country:US
Mailing Address - Phone:402-916-4539
Mailing Address - Fax:402-403-5857
Practice Address - Street 1:8610 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3377
Practice Address - Country:US
Practice Address - Phone:402-916-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty