Provider Demographics
NPI:1639857899
Name:RAMOS GUILLEN, LUIS JAVIER SR
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:JAVIER
Last Name:RAMOS GUILLEN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 NW 97TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-2234
Mailing Address - Country:US
Mailing Address - Phone:786-764-2648
Mailing Address - Fax:
Practice Address - Street 1:3355 NW 97TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-2234
Practice Address - Country:US
Practice Address - Phone:786-764-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-282122106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician