Healthcare Provider Details

I. General information

NPI: 1225749971
Provider Name (Legal Business Name): MARCOS RAMIREZ IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 US-98
PENSACOLA FL
32512-7000
US

IV. Provider business mailing address

159 ORVIL WAY
FALLBROOK CA
92028-2539
US

V. Phone/Fax

Practice location:
  • Phone: 817-733-1135
  • Fax:
Mailing address:
  • Phone: 817-733-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: