Provider Demographics
NPI:1437868379
Name:RAMOS FERNANDEZ, MIREIDYS
Entity Type:Individual
Prefix:
First Name:MIREIDYS
Middle Name:
Last Name:RAMOS FERNANDEZ
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 1:14257 SW 151ST CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5615
Mailing Address - Country:US
Mailing Address - Phone:786-570-4462
Mailing Address - Fax:
Practice Address - Street 1:14257 SW 151ST CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-5615
Practice Address - Country:US
Practice Address - Phone:786-570-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-243878106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician