Provider Demographics
NPI:1952141194
Name:RAMIREZ LOPEZ, ROMAN JAVIER
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:JAVIER
Last Name:RAMIREZ LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 W OKALOOSA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-1029
Mailing Address - Country:US
Mailing Address - Phone:813-409-9664
Mailing Address - Fax:
Practice Address - Street 1:2219 W OKALOOSA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-1029
Practice Address - Country:US
Practice Address - Phone:813-409-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL105140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist