Healthcare Provider Details

I. General information

NPI: 1245874767
Provider Name (Legal Business Name): ANDREA EVANGELINA RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

PO BOX 60259
LOS ANGELES CA
90060-0259
US

V. Phone/Fax

Practice location:
  • Phone: 888-388-7184
  • Fax:
Mailing address:
  • Phone: 877-346-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: