Provider Demographics
NPI:1679002604
Name:RAMIREZ, LINA ALEJANDRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:ALEJANDRA
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 BAYSIDE LAKES BLVD SE
Mailing Address - Street 2:#1
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909
Mailing Address - Country:US
Mailing Address - Phone:321-984-0044
Mailing Address - Fax:
Practice Address - Street 1:3590 BAYSIDE LAKES BLVD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6866
Practice Address - Country:US
Practice Address - Phone:321-544-7036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist