Healthcare Provider Details

I. General information

NPI: 1790025823
Provider Name (Legal Business Name): TIM V RAMIREZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PAULARINO AVE A168
COSTA MESA CA
92626-3301
US

IV. Provider business mailing address

150 PAULARINO AVE A168
COSTA MESA CA
92626-3301
US

V. Phone/Fax

Practice location:
  • Phone: 949-677-7763
  • Fax: 949-209-2624
Mailing address:
  • Phone: 949-677-7763
  • Fax: 949-209-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC27157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: