Healthcare Provider Details

I. General information

NPI: 1164339503
Provider Name (Legal Business Name): CHAYANNE RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 MAGNOLIA AVE
RIVERSIDE CA
92503-3609
US

IV. Provider business mailing address

9707 MAGNOLIA AVE
RIVERSIDE CA
92503-3609
US

V. Phone/Fax

Practice location:
  • Phone: 951-410-8211
  • Fax:
Mailing address:
  • Phone: 951-410-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number220130296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: