Healthcare Provider Details

I. General information

NPI: 1114294618
Provider Name (Legal Business Name): BARDO RAMOS MSW, ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD.
LOS ANGELES CA
90073
US

IV. Provider business mailing address

11301 WILSHIRE BLVD.
LOS ANGELES CA
90073
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax: 310-268-4864
Mailing address:
  • Phone: 310-478-3711
  • Fax: 310-268-4864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: