Healthcare Provider Details

I. General information

NPI: 1992633895
Provider Name (Legal Business Name): RUDY RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 COLONY DR
CAMARILLO CA
93012-5203
US

IV. Provider business mailing address

4707 COLONY DR
CAMARILLO CA
93012-5203
US

V. Phone/Fax

Practice location:
  • Phone: 805-275-6368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: