Healthcare Provider Details

I. General information

NPI: 1235750647
Provider Name (Legal Business Name): DAVID RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 7TH AVE STE 150
SANTA CRUZ CA
95062-4669
US

IV. Provider business mailing address

200 7TH AVE STE 150
SANTA CRUZ CA
95062-4669
US

V. Phone/Fax

Practice location:
  • Phone: 831-462-1060
  • Fax: 831-462-4970
Mailing address:
  • Phone: 831-462-1060
  • Fax: 831-462-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1312940618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: