Healthcare Provider Details

I. General information

NPI: 1407700834
Provider Name (Legal Business Name): RAMON AVITIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 S BROADWAY
SANTA MARIA CA
93454-6914
US

IV. Provider business mailing address

1444 S BROADWAY STE B
SANTA MARIA CA
93454-6914
US

V. Phone/Fax

Practice location:
  • Phone: 805-335-4757
  • Fax:
Mailing address:
  • Phone: 805-335-4757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW136283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: