Basic Information
| Provider Information | |||||||||
| NPI: | 1467761577 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMOS | ||||||||
| FirstName: | MODESTO | ||||||||
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| Credential: | IMH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10671 N KENDALL DR | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331761510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054160811 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 701 SW 27TH AVE | ||||||||
| Address2: | SUITE G20 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331353031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056437800 | ||||||||
| FaxNumber: | 3056431345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2010 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.