Healthcare Provider Details

I. General information

NPI: 1891296752
Provider Name (Legal Business Name): DOMINIC GONZALEZ-RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4244 W MINERAL KING AVE
VISALIA CA
93291-5448
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 559-492-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-33105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: