Healthcare Provider Details

I. General information

NPI: 1013355486
Provider Name (Legal Business Name): GRACIE RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S 2ND AVE
COVINA CA
91723-3012
US

IV. Provider business mailing address

6271 KINLOCK AVE
RANCHO CUCAMONGA CA
91737-3725
US

V. Phone/Fax

Practice location:
  • Phone: 626-974-8122
  • Fax:
Mailing address:
  • Phone: 909-247-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: