Healthcare Provider Details

I. General information

NPI: 1083536676
Provider Name (Legal Business Name): FELIPE MARTINEZ-RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26888 LA PAZ RD STE B
ALISO VIEJO CA
92656-3049
US

IV. Provider business mailing address

15250 BLACKOAK LN
FONTANA CA
92336-4476
US

V. Phone/Fax

Practice location:
  • Phone: 949-362-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: