Provider Demographics
NPI:1790390045
Name:REYES RAMOS, AZALIA MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:AZALIA
Middle Name:MICHELLE
Last Name:REYES RAMOS
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 1:381 AUTUMN BREEZE WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3940
Mailing Address - Country:US
Mailing Address - Phone:407-907-8860
Mailing Address - Fax:
Practice Address - Street 1:381 AUTUMN BREEZE WAY
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3940
Practice Address - Country:US
Practice Address - Phone:407-907-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator