Healthcare Provider Details

I. General information

NPI: 1528677259
Provider Name (Legal Business Name): ZAYNE EDWARD BOUDREAUXRAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ZAYNE EDWARD RAMIREZ

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E COOLEY DR STE 240
COLTON CA
92324-3936
US

IV. Provider business mailing address

1430 E COOLEY DR STE 240
COLTON CA
92324-3936
US

V. Phone/Fax

Practice location:
  • Phone: 909-514-1404
  • Fax:
Mailing address:
  • Phone: 909-514-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: