Healthcare Provider Details

I. General information

NPI: 1669398293
Provider Name (Legal Business Name): JONATHAN ANTHONY RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE STE 500
LONG BEACH CA
90806-2330
US

IV. Provider business mailing address

1925 E LA VETA AVE SPC 46
ORANGE CA
92866-2931
US

V. Phone/Fax

Practice location:
  • Phone: 562-304-1740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95455954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: