Provider Demographics
NPI:1245682590
Name:RAMOS, JESSICA (OTA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 HARBOUR BLVD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6557
Mailing Address - Country:US
Mailing Address - Phone:954-756-5346
Mailing Address - Fax:
Practice Address - Street 1:2153 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2631
Practice Address - Country:US
Practice Address - Phone:305-856-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13402171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor