Healthcare Provider Details

I. General information

NPI: 1043677875
Provider Name (Legal Business Name): BETHANY L RAMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 TERRA NOVA BLVD
PACIFICA CA
94044-3615
US

IV. Provider business mailing address

1432 TERRA NOVA BLVD
PACIFICA CA
94044-3615
US

V. Phone/Fax

Practice location:
  • Phone: 512-470-4228
  • Fax:
Mailing address:
  • Phone: 512-470-4228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11518116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: