Provider Demographics
NPI:1730965062
Name:RAMOS YON, KEILY LEEN
Entity type:Individual
Prefix:
First Name:KEILY
Middle Name:LEEN
Last Name:RAMOS YON
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 1:25965 W ASH AVE
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85193-7716
Mailing Address - Country:US
Mailing Address - Phone:152-070-5534
Mailing Address - Fax:
Practice Address - Street 1:25965 W ASH AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85193-7716
Practice Address - Country:US
Practice Address - Phone:520-705-5341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-25093225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist