Provider Demographics
NPI:1902361751
Name:RAMOS, MIREJILDO TREY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MIREJILDO
Middle Name:TREY
Last Name:RAMOS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1784
Mailing Address - Country:US
Mailing Address - Phone:972-746-8917
Mailing Address - Fax:940-584-0651
Practice Address - Street 1:5321 WATERFORD DR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1784
Practice Address - Country:US
Practice Address - Phone:972-746-8917
Practice Address - Fax:940-584-0651
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140499367500000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered