Provider Demographics
NPI:1972855435
Name:RAMIREZ, LIZETTE KARINA (STA)
Entity Type:Individual
Prefix:
First Name:LIZETTE
Middle Name:KARINA
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:STA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 BLUEMIST PT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-6300
Mailing Address - Country:US
Mailing Address - Phone:210-551-5525
Mailing Address - Fax:
Practice Address - Street 1:7206 BLUEMIST PT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6300
Practice Address - Country:US
Practice Address - Phone:210-551-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37218235Z00000X
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1972855435Medicaid
TX207164901Medicaid
TX149984001Medicaid
TX676535Medicare PIN