Provider Demographics
NPI:1740801968
Name:RAMOS RODRIGUEZ, GRISEL ARACELIN (LCDA)
Entity type:Individual
Prefix:
First Name:GRISEL
Middle Name:ARACELIN
Last Name:RAMOS RODRIGUEZ
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 SARNER PASS WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-9421
Mailing Address - Country:US
Mailing Address - Phone:787-615-6700
Mailing Address - Fax:
Practice Address - Street 1:415 E MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4703
Practice Address - Country:US
Practice Address - Phone:863-356-8821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1564133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1564OtherLICENSE