Provider Demographics
NPI:1912724055
Name:RAMIREZ, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:VILLACIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4350 NW 30TH ST APT 132
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2154
Mailing Address - Country:US
Mailing Address - Phone:954-627-2276
Mailing Address - Fax:
Practice Address - Street 1:4350 NW 30TH ST APT 132
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-2154
Practice Address - Country:US
Practice Address - Phone:954-627-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5133133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered