Basic Information
Provider Information
NPI: 1003142555
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAMIREZ
FirstName: JOANNA
MiddleName: G
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 214 MORRISON RD
Address2: STE 110
City: BRANDON
State: FL
PostalCode: 335114849
CountryCode: US
TelephoneNumber: 8138444300
FaxNumber: 8138441909
Practice Location
Address1: 214 MORRISON RD
Address2: STE 110
City: BRANDON
State: FL
PostalCode: 335114849
CountryCode: US
TelephoneNumber: 8138444300
FaxNumber: 8138441909
Other Information
ProviderEnumerationDate: 10/19/2009
LastUpdateDate: 09/04/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XME107535FLN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XBP10025229TXN Allopathic & Osteopathic PhysiciansInternal Medicine 
208000000XME107535FLY Allopathic & Osteopathic PhysiciansPediatrics 

ID Information
IDTypeStateIssuerDescription
00319220005FL MEDICAID


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