Provider Demographics
NPI:1295546828
Name:RAMIREZ CASTANO, LEYDY CAROLINA
Entity type:Individual
Prefix:
First Name:LEYDY
Middle Name:CAROLINA
Last Name:RAMIREZ CASTANO
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 1:40 QUARRY ST APT A
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4334
Mailing Address - Country:US
Mailing Address - Phone:203-895-6240
Mailing Address - Fax:
Practice Address - Street 1:40 QUARRY ST APT A
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4334
Practice Address - Country:US
Practice Address - Phone:203-895-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 171400000X
CT86392786136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171400000XOther Service ProvidersHealth & Wellness Coach