Provider Demographics
NPI:1952923849
Name:MIRAMONTES, RAYCHEL ELIZABETH
Entity type:Individual
Prefix:
First Name:RAYCHEL
Middle Name:ELIZABETH
Last Name:MIRAMONTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 CONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-9280
Mailing Address - Country:US
Mailing Address - Phone:937-308-1215
Mailing Address - Fax:
Practice Address - Street 1:1930 PRIME CT STE 105
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-9045
Practice Address - Country:US
Practice Address - Phone:937-339-7982
Practice Address - Fax:937-339-7842
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty