Healthcare Provider Details

I. General information

NPI: 1457789943
Provider Name (Legal Business Name): FELICIA RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date: 04/24/2018
Reactivation Date: 05/02/2018

III. Provider practice location address

510 16TH ST
OAKLAND CA
94612-1520
US

IV. Provider business mailing address

510 16TH ST
OAKLAND CA
94612-1520
US

V. Phone/Fax

Practice location:
  • Phone: 510-357-5515
  • Fax: 510-357-5112
Mailing address:
  • Phone: 510-357-5515
  • Fax: 510-357-5112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: