Healthcare Provider Details

I. General information

NPI: 1912114489
Provider Name (Legal Business Name): MR. CARLOS RAFAEL RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3747 MIDWAY DR
SAN DIEGO CA
92110-5204
US

IV. Provider business mailing address

3747 MIDWAY DR
SAN DIEGO CA
92110-5204
US

V. Phone/Fax

Practice location:
  • Phone: 619-923-1920
  • Fax:
Mailing address:
  • Phone: 619-923-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: