Healthcare Provider Details

I. General information

NPI: 1184910366
Provider Name (Legal Business Name): KEVIN MICHAEL RAMOTAR M.A., PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2011
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR # MC0304 2ND FLOOR
LA JOLLA CA
92093-0304
US

IV. Provider business mailing address

PO BOX 12204
LA JOLLA CA
92039-2204
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-3755
  • Fax:
Mailing address:
  • Phone: 661-524-5726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: