Healthcare Provider Details

I. General information

NPI: 1619895661
Provider Name (Legal Business Name): MARYLU RAMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23550 LYONS AVE STE 208
NEWHALL CA
91321-5742
US

IV. Provider business mailing address

23550 LYONS AVE STE 208
NEWHALL CA
91321-5742
US

V. Phone/Fax

Practice location:
  • Phone: 818-568-8204
  • Fax:
Mailing address:
  • Phone: 818-642-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number191628BP
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: