Healthcare Provider Details

I. General information

NPI: 1073144010
Provider Name (Legal Business Name): MISS MELISSA ALEXIS RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2667 CAMINO DEL RIO S STE 102
SAN DIEGO CA
92108-3763
US

IV. Provider business mailing address

3604 BEYER BLVD APT 36-203
SAN YSIDRO CA
92173-1976
US

V. Phone/Fax

Practice location:
  • Phone: 619-782-0700
  • Fax:
Mailing address:
  • Phone: 619-836-2366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-210218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: