Healthcare Provider Details

I. General information

NPI: 1063910883
Provider Name (Legal Business Name): EDITH RAMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E HERNDON AVE
FRESNO CA
93720-3306
US

IV. Provider business mailing address

1313 E HERNDON AVE STE 203
FRESNO CA
93720-3306
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-6808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: