Healthcare Provider Details

I. General information

NPI: 1104969112
Provider Name (Legal Business Name): ROBERT RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 E SAGINAW WAY SUITE #102
FRESNO CA
93704-4458
US

IV. Provider business mailing address

813 S. B ST.
MADERA CA
93638-4823
US

V. Phone/Fax

Practice location:
  • Phone: 559-274-0299
  • Fax: 559-244-0328
Mailing address:
  • Phone: 559-274-0341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: