Provider Demographics
NPI:1720060007
Name:RAMOS, LISA (RD, LD, CDE, CD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:RD, LD, CDE, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 AUBURN PARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2387
Mailing Address - Country:US
Mailing Address - Phone:260-490-2229
Mailing Address - Fax:260-490-3807
Practice Address - Street 1:10215 AUBURN PARK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2387
Practice Address - Country:US
Practice Address - Phone:260-490-2229
Practice Address - Fax:260-490-3807
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN184730JMedicare PIN