Healthcare Provider Details

I. General information

NPI: 1316863459
Provider Name (Legal Business Name): SALVADOR ANTONIO ABSALON RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

3025 COUNTRY CLUB BLVD
STOCKTON CA
95204-3903
US

IV. Provider business mailing address

3025 COUNTRY CLUB BLVD
STOCKTON CA
95204-3903
US

V. Phone/Fax

Practice location:
  • Phone: 209-922-5587
  • Fax:
Mailing address:
  • Phone: 209-922-5587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: