Healthcare Provider Details

I. General information

NPI: 1043693781
Provider Name (Legal Business Name): EDWARD RAMIREZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 ELM AVE
LONG BEACH CA
90802
US

IV. Provider business mailing address

456 ELM AVE
LONG BEACH CA
90802-2426
US

V. Phone/Fax

Practice location:
  • Phone: 562-437-6717
  • Fax: 562-437-5072
Mailing address:
  • Phone: 562-437-6717
  • Fax: 562-437-5072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number74645
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number74645
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW105916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: