Provider Demographics
NPI:1538901558
Name:REYES RAMIREZ, ELBA ROSA (DH)
Entity type:Individual
Prefix:
First Name:ELBA
Middle Name:ROSA
Last Name:REYES RAMIREZ
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 NW 45TH AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2476
Mailing Address - Country:US
Mailing Address - Phone:786-366-3048
Mailing Address - Fax:
Practice Address - Street 1:950 NW 45TH AVE APT 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2476
Practice Address - Country:US
Practice Address - Phone:786-366-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH30007124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty