Provider Demographics
NPI:1770623795
Name:RAMIREZ, MAYRA LIZETTE (LND)
Entity type:Individual
Prefix:MISS
First Name:MAYRA
Middle Name:LIZETTE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 CALLE CANEY
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3854
Mailing Address - Country:US
Mailing Address - Phone:787-501-5252
Mailing Address - Fax:
Practice Address - Street 1:AVE. CAMPO RICO A-6 CASTELLANA GARDENS
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-752-7897
Practice Address - Fax:787-768-0689
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1463133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist