Healthcare Provider Details

I. General information

NPI: 1881008878
Provider Name (Legal Business Name): RAFAEL RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N FIRST STE 135, 154, 112 & 124
FRESNO CA
93726
US

IV. Provider business mailing address

3636 N 1ST ST STE 112
FRESNO CA
93726-6818
US

V. Phone/Fax

Practice location:
  • Phone: 559-476-2166
  • Fax:
Mailing address:
  • Phone: 559-436-0482
  • Fax: 844-587-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number274805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: