Healthcare Provider Details

I. General information

NPI: 1700014891
Provider Name (Legal Business Name): REBECCA LYNN RAMIREZ LVN, AS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 NORTHCREST DR
CRESCENT CITY CA
95531-2313
US

IV. Provider business mailing address

880 NORTHCREST DR
CRESCENT CITY CA
95531-2313
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-3191
  • Fax: 707-465-6701
Mailing address:
  • Phone: 707-464-3191
  • Fax: 707-465-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN229342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: