Healthcare Provider Details

I. General information

NPI: 1063379360
Provider Name (Legal Business Name): ERSULA LEONE RAMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S C ST STE A
LOMPOC CA
93436-6924
US

IV. Provider business mailing address

833 N F ST APT E
LOMPOC CA
93436-4143
US

V. Phone/Fax

Practice location:
  • Phone: 805-741-7853
  • Fax:
Mailing address:
  • Phone: 805-741-7853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: