MEDICARE: GUSTAVO ANTONIO RAMOS PPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor	220139790	CA

General Provider Information

NPI Number	:	1013896075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO ANTONIO RAMOS PPS

Provider Business Mailing Address
First Line	:	525 TERAN DR
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3245
Country	:	US
Telephone Number	:	760-214-0116
Fax Number	:

Provider Business Practice Location Address
First Line	:	1743 RECHE RD
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3624
Country	:	US
Telephone Number	:	760-695-9810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2025
Last Update Date	:	09/02/2025

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