Provider Demographics
NPI:1396209995
Name:BRICENO RAMIREZ, ALISA
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:BRICENO RAMIREZ
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 1:156 WILLIAM ST RM 303
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-5307
Mailing Address - Country:US
Mailing Address - Phone:888-803-3370
Mailing Address - Fax:888-803-3331
Practice Address - Street 1:156 WILLIAM ST RM 303
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5307
Practice Address - Country:US
Practice Address - Phone:888-803-3370
Practice Address - Fax:888-803-3331
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308712-1363LA2200X, 363LA2200X
NJ26NJ01257000363LA2200X
FLAPRN11007332363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health