Provider Demographics
NPI:1295377950
Name:RAMOS MONTEAGUDO, EGGLY
Entity Type:Individual
Prefix:
First Name:EGGLY
Middle Name:
Last Name:RAMOS MONTEAGUDO
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 1:100 FONTAINEBLEAU BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4572
Mailing Address - Country:US
Mailing Address - Phone:786-560-9694
Mailing Address - Fax:
Practice Address - Street 1:100 FONTAINEBLEAU BLVD APT 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4572
Practice Address - Country:US
Practice Address - Phone:786-560-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01910115106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst