Provider Demographics
NPI:1114914793
Name:RAMIREZ, LINA (MD)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
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:PO BOX 11457
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-1457
Mailing Address - Country:US
Mailing Address - Phone:954-566-7775
Mailing Address - Fax:954-566-9997
Practice Address - Street 1:1815 E COMMERCIAL BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3760
Practice Address - Country:US
Practice Address - Phone:954-566-7775
Practice Address - Fax:954-566-9997
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00092033YAMedicaid
GA00092033YAMedicaid
H52629Medicare UPIN