Healthcare Provider Details

I. General information

NPI: 1699049924
Provider Name (Legal Business Name): MILTON RAFAEL RAMIREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36450 INLAND VALLEY DR
WILDOMAR CA
92595-9583
US

IV. Provider business mailing address

36450 INLAND VALLEY DR
WILDOMAR CA
92595-9583
US

V. Phone/Fax

Practice location:
  • Phone: 866-984-7483
  • Fax:
Mailing address:
  • Phone: 866-984-7483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA125445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: