Healthcare Provider Details

I. General information

NPI: 1144942145
Provider Name (Legal Business Name): MARIO RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84592 12TH ST
TRONA CA
93562-2430
US

IV. Provider business mailing address

84592 12TH ST
TRONA CA
93562-2430
US

V. Phone/Fax

Practice location:
  • Phone: 760-927-8825
  • Fax:
Mailing address:
  • Phone: 760-927-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: