1336355684 NPI number — MR. RAMON MAISONET M.A.

Table of content: MR. RAMON MAISONET M.A. (NPI 1336355684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336355684 NPI number — MR. RAMON MAISONET M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAISONET
Provider First Name:
RAMON
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAISONET GONZALEZ
Provider Other First Name:
RAMON
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1336355684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7349 ULMERTON RD LOT 247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33771-4804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-607-6846
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4024 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33711-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-327-7656
Provider Business Practice Location Address Fax Number:
727-322-2130
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  1789 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: MH21695 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 21695 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: M253720602590 . This is a "DRIVERS LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1376 . This is a "APS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 5197 . This is a "INTERNATIONAL MED CARD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 116985300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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