Healthcare Provider Details

I. General information

NPI: 1962063271
Provider Name (Legal Business Name): ROGELIO RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 08/01/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SIXTH ST
POINT REYES STATION CA
94956
US

IV. Provider business mailing address

1179 N MCDOWELL BLVD
PETALUMA CA
94954-6559
US

V. Phone/Fax

Practice location:
  • Phone: 707-559-7500
  • Fax:
Mailing address:
  • Phone: 707-559-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number127011
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number127011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: