Healthcare Provider Details

I. General information

NPI: 1295243582
Provider Name (Legal Business Name): JUANILLO RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W REDONDO BEACH BLVD
GARDENA CA
90247-3511
US

IV. Provider business mailing address

21009 WOOD AVE APT A
TORRANCE CA
90503-4128
US

V. Phone/Fax

Practice location:
  • Phone: 310-532-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number33085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: