Provider Demographics
NPI:1225574189
Name:CONSUEGRA RAMOS, MARITZA M
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:M
Last Name:CONSUEGRA RAMOS
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 1:2733 NE 3RD CT UNIT 102
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7083
Mailing Address - Country:US
Mailing Address - Phone:786-277-7283
Mailing Address - Fax:
Practice Address - Street 1:2733 NE 3RD CT UNIT 102
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7083
Practice Address - Country:US
Practice Address - Phone:786-277-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT1999188106S00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst