Healthcare Provider Details

I. General information

NPI: 1164191805
Provider Name (Legal Business Name): SUSAN ELAINE BARRERA RAMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 S MAYFLOWER AVE STE 420
MONROVIA CA
91016-5256
US

IV. Provider business mailing address

2062 CAPEHART AVE
DUARTE CA
91010-3266
US

V. Phone/Fax

Practice location:
  • Phone: 626-566-7001
  • Fax:
Mailing address:
  • Phone: 626-275-8947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: