Healthcare Provider Details

I. General information

NPI: 1639646540
Provider Name (Legal Business Name): ANDREW BAYANI DE RAMOS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4099 N MISSION RD
LOS ANGELES CA
90032-2697
US

IV. Provider business mailing address

4099 N MISSION RD STE A
LOS ANGELES CA
90032-2697
US

V. Phone/Fax

Practice location:
  • Phone: 323-221-1746
  • Fax: 323-221-5176
Mailing address:
  • Phone: 323-221-1746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number141440
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW96335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: