Provider Demographics
NPI:1265989537
Name:RAMIREZ, QUETZAILI MARGARITA
Entity type:Individual
Prefix:MS
First Name:QUETZAILI
Middle Name:MARGARITA
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 204TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3110
Mailing Address - Country:US
Mailing Address - Phone:718-354-5008
Mailing Address - Fax:
Practice Address - Street 1:4722 204TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3110
Practice Address - Country:US
Practice Address - Phone:718-354-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY930356382OtherEMBLEM HEALTH
NY93035682OtherGHI EMPIRE BLUE CROSS BLUE SHIELD