Provider Demographics
NPI:1396738134
Name:RAMIREZ, JUAN MANUEL (MS RD)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:MANUEL
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:MS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 BRIDLEBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2776
Mailing Address - Country:US
Mailing Address - Phone:334-279-3703
Mailing Address - Fax:
Practice Address - Street 1:50 W ASH ST
Practice Address - Street 2:BLDG 841
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112-5954
Practice Address - Country:US
Practice Address - Phone:334-593-7117
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered