Provider Demographics
NPI:1891322103
Name:RAMIREZ, DIANA IVETTE (LAT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:IVETTE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 S MESA HILLS DR APT 17
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5512
Mailing Address - Country:US
Mailing Address - Phone:915-227-3263
Mailing Address - Fax:
Practice Address - Street 1:301 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-3850
Practice Address - Country:US
Practice Address - Phone:915-434-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174H00000X
TXAT18152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT1815OtherTDLR