Healthcare Provider Details

I. General information

NPI: 1710596648
Provider Name (Legal Business Name): MANUEL RAMONE FERDINAND JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 N BUSH ST
SANTA ANA CA
92706-2816
US

IV. Provider business mailing address

1910 N BUSH ST
SANTA ANA CA
92706-2816
US

V. Phone/Fax

Practice location:
  • Phone: 714-361-7950
  • Fax:
Mailing address:
  • Phone: 714-361-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number36892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: