Healthcare Provider Details

I. General information

NPI: 1558061523
Provider Name (Legal Business Name): VICTOR GABRIEL RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 LEBEC ROAD
LEBEC CA
93243
US

IV. Provider business mailing address

704 LEBEC ROAD
LEBEC CA
93243
US

V. Phone/Fax

Practice location:
  • Phone: 661-248-5250
  • Fax: 661-248-5279
Mailing address:
  • Phone: 661-248-5250
  • Fax: 661-248-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: