Healthcare Provider Details

I. General information

NPI: 1609690692
Provider Name (Legal Business Name): ARELY AGUAYO RAMOS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 12/01/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3823 V ST
SACRAMENTO CA
95817-3145
US

IV. Provider business mailing address

3823 V ST
SACRAMENTO CA
95817-3145
US

V. Phone/Fax

Practice location:
  • Phone: 530-351-3137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License NumberL9972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: