Healthcare Provider Details

I. General information

NPI: 1063174282
Provider Name (Legal Business Name): DIANA RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S CALIFORNIA AVE
CHICAGO IL
60608-2486
US

IV. Provider business mailing address

2237 S 11TH AVE
NORTH RIVERSIDE IL
60546-1122
US

V. Phone/Fax

Practice location:
  • Phone: 773-584-6200
  • Fax:
Mailing address:
  • Phone: 773-744-3128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: