Healthcare Provider Details

I. General information

NPI: 1033035183
Provider Name (Legal Business Name): ELLYNORE ROSE ENRIQUEZ RAMIREZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SHAFFER RD STE A
SANTA CRUZ CA
95060-5763
US

IV. Provider business mailing address

2004 JACINTO DR
OXNARD CA
93030-8095
US

V. Phone/Fax

Practice location:
  • Phone: 831-420-0120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: