Healthcare Provider Details

I. General information

NPI: 1699210591
Provider Name (Legal Business Name): STACEY RAMIREZ APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 E LAKESHORE DR
LAKE ELSINORE CA
92530-4446
US

IV. Provider business mailing address

29662 EDGEMERE WAY
MENIFEE CA
92584-6451
US

V. Phone/Fax

Practice location:
  • Phone: 951-471-1426
  • Fax:
Mailing address:
  • Phone: 909-659-6055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18142
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number160133412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: