Healthcare Provider Details

I. General information

NPI: 1497768311
Provider Name (Legal Business Name): MILDRED RAMOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

IV. Provider business mailing address

PO BOX 6388
SAN PEDRO CA
90734-6388
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-6317
  • Fax: 951-765-4829
Mailing address:
  • Phone: 310-225-3244
  • Fax: 310-698-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG52193
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberG52193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: