Healthcare Provider Details

I. General information

NPI: 1205769577
Provider Name (Legal Business Name): JESUS M. RAMIREZ SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15668 DALE EVANS PKWY
APPLE VALLEY CA
92307-3267
US

IV. Provider business mailing address

15668 DALE EVANS PKWY # 92307
APPLE VALLEY CA
92307-3267
US

V. Phone/Fax

Practice location:
  • Phone: 323-318-4100
  • Fax: 323-318-4100
Mailing address:
  • Phone: 323-318-4100
  • Fax: 323-318-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: