Provider Demographics
NPI:1427624691
Name:RAMIREZ, DESTINY BRISA
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:BRISA
Last Name: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 1:4202 E CACTUS RD APT 4211
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7665
Mailing Address - Country:US
Mailing Address - Phone:310-363-3202
Mailing Address - Fax:
Practice Address - Street 1:4202 E CACTUS RD APT 4211
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7665
Practice Address - Country:US
Practice Address - Phone:310-363-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD10562998390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program