Provider Demographics
NPI:1053131508
Name:OLIVA RAMIREZ, RAQUEL LILIANA
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:LILIANA
Last Name:OLIVA RAMIREZ
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 1:2351 GIMLET AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-4832
Mailing Address - Country:US
Mailing Address - Phone:305-992-1738
Mailing Address - Fax:
Practice Address - Street 1:2351 GIMLET AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-4832
Practice Address - Country:US
Practice Address - Phone:305-992-1738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-353096106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician