Healthcare Provider Details

I. General information

NPI: 1174940944
Provider Name (Legal Business Name): JUAN SALVADOR RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 LANGSDORF DR STE 200
FULLERTON CA
92831-3702
US

IV. Provider business mailing address

680 LANGSDORF DR STE 200
FULLERTON CA
92831-3702
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-9264
  • Fax: 714-871-5032
Mailing address:
  • Phone: 714-871-9264
  • Fax: 714-871-5032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number98062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: