Provider Demographics
NPI:1720454150
Name:RAMIREZ, MAYRA ROSANNA (CNA)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:ROSANNA
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:ROSANNA
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3140 SHINGLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-6583
Mailing Address - Country:US
Mailing Address - Phone:407-219-6531
Mailing Address - Fax:
Practice Address - Street 1:3140 SHINGLE CREEK CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-6583
Practice Address - Country:US
Practice Address - Phone:407-219-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA251557376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide