Provider Demographics
NPI:1285404392
Name:RAMIREZ DEVILLAVICENCIO, LORELEI
Entity type:Individual
Prefix:
First Name:LORELEI
Middle Name:
Last Name:RAMIREZ DEVILLAVICENCIO
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 1:7770 NW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5708
Mailing Address - Country:US
Mailing Address - Phone:305-926-1653
Mailing Address - Fax:
Practice Address - Street 1:28715 SW 132ND AVE STE 132
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7444
Practice Address - Country:US
Practice Address - Phone:305-926-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant