Provider Demographics
NPI:1326779893
Name:RAMIREZ, HANNAH MICHELLE
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:MICHELLE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:MICHELLE
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 GATEWAY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7066
Mailing Address - Country:US
Mailing Address - Phone:407-319-1292
Mailing Address - Fax:
Practice Address - Street 1:5824 MARBLE CT
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9339
Practice Address - Country:US
Practice Address - Phone:407-319-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-22-219775106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7829499144Medicaid