Healthcare Provider Details

I. General information

NPI: 1033783121
Provider Name (Legal Business Name): SAMIRA RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 LIMONITE AVE
RIVERSIDE CA
92509-6108
US

IV. Provider business mailing address

9971 PEPPER AVE
FONTANA CA
92335-6613
US

V. Phone/Fax

Practice location:
  • Phone: 951-361-0263
  • Fax:
Mailing address:
  • Phone: 951-217-5282
  • Fax: 951-361-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number65040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: