Healthcare Provider Details

I. General information

NPI: 1619198785
Provider Name (Legal Business Name): RAMY HATEM EBEID
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAMY HATEM MOHAMED EBEID

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SOLANO AVE
VALLEJO CA
94590-6456
US

IV. Provider business mailing address

330 CRISP AVE
VALLEJO CA
94592-1126
US

V. Phone/Fax

Practice location:
  • Phone: 707-552-1476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: