Healthcare Provider Details

I. General information

NPI: 1639141278
Provider Name (Legal Business Name): RENIE ANSAY RAMOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E 7TH ST SUITE N
UPLAND CA
91786-6701
US

IV. Provider business mailing address

PO BOX 511
UPLAND CA
91785-0511
US

V. Phone/Fax

Practice location:
  • Phone: 909-946-7647
  • Fax: 909-981-3770
Mailing address:
  • Phone: 909-946-7647
  • Fax: 909-981-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA33236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: