Provider Demographics
NPI:1922056860
Name:RAMIREZ, GLENDA E (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:E
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:787-754-5393
Mailing Address - Fax:787-754-5393
Practice Address - Street 1:731 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1603
Practice Address - Country:US
Practice Address - Phone:386-257-1626
Practice Address - Fax:866-899-3686
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12416174400000X, 207R00000X, 207RG0300X
FLME134809207R00000X
PR12417207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020040Medicare ID - Type UnspecifiedGERIATRIST
PRH69256Medicare UPIN