Healthcare Provider Details

I. General information

NPI: 1356785505
Provider Name (Legal Business Name): AILEEN N. RAMGREN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25485 MEDICAL CENTER DR. SUITE 220
MARRIETA CA
92562-6927
US

IV. Provider business mailing address

3880 MURPHY CANYON RD. SUITE 200
SAN DIEGO CA
92123-4411
US

V. Phone/Fax

Practice location:
  • Phone: 951-461-9300
  • Fax: 951-461-9399
Mailing address:
  • Phone: 858-636-4300
  • Fax: 858-636-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A14418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: