Healthcare Provider Details

I. General information

NPI: 1275345076
Provider Name (Legal Business Name): JOSE RAMON ISRAEL ORNELAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US NMRTC OKINAWA PSC 482
FPO AP
96362-1600
US

IV. Provider business mailing address

US NMRTC OKINAWA PSC 482
FPO AP
96362-1600
US

V. Phone/Fax

Practice location:
  • Phone: 315-646-7555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: