Healthcare Provider Details

I. General information

NPI: 1689482804
Provider Name (Legal Business Name): FERDISON KYLE RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2681 E TYLER ST
LONG BEACH CA
90810-1336
US

IV. Provider business mailing address

2681 E TYLER ST
LONG BEACH CA
90810-1336
US

V. Phone/Fax

Practice location:
  • Phone: 562-881-5460
  • Fax:
Mailing address:
  • Phone: 562-881-5460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: