MEDICARE: MR. RUPERT MARASIGAN RAMIREZ NP

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	363L00000X	Nurse Practitioner	95016550	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95127972	OTHER	CA	RN LICENSE NUMBER
2	95016550	OTHER	CA	NP LICENSE NUMBER

General Provider Information

NPI Number	:	1528650165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUPERT MARASIGAN RAMIREZ NP

Provider Business Mailing Address
First Line	:	3353 LAS VEGAS DR
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-3809
Country	:	US
Telephone Number	:	619-764-1214
Fax Number	:

Provider Business Practice Location Address
First Line	:	3353 LAS VEGAS DR
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-3809
Country	:	US
Telephone Number	:	619-764-1214
Fax Number	:

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

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	02/05/2021

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