Healthcare Provider Details

I. General information

NPI: 1124542238
Provider Name (Legal Business Name): BLANCA ESTELA RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11429 VALLEY BLVD
EL MONTE CA
91731-3229
US

IV. Provider business mailing address

PO BOX 4866
LA PUENTE CA
91747-4866
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-3000
  • Fax:
Mailing address:
  • Phone: 626-383-5650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number83887
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: