Healthcare Provider Details

I. General information

NPI: 1114252822
Provider Name (Legal Business Name): GABRIEL RAMIREZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GABRIEL RAMIREZ PA-C

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 SIERRA COLLEGE DR
GRASS VALLEY CA
95945-5768
US

IV. Provider business mailing address

10495 W PIPER LN
NEVADA CITY CA
95959-8709
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-9541
  • Fax: 530-271-7036
Mailing address:
  • Phone: 805-824-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: