Healthcare Provider Details

I. General information

NPI: 1730026089
Provider Name (Legal Business Name): KEVIN VALENCIA RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 RIDDER PARK DR
SAN JOSE CA
95131-2313
US

IV. Provider business mailing address

4300 THE WOODS DR APT D2303
SAN JOSE CA
95136-3890
US

V. Phone/Fax

Practice location:
  • Phone: 408-225-9163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: