Healthcare Provider Details

I. General information

NPI: 1487246922
Provider Name (Legal Business Name): ITHAMAR LOPEZ RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CHANLON RD
NEW PROVIDENCE NJ
07974-1543
US

IV. Provider business mailing address

2342 PROFESSIONAL PKWY STE 300
SANTA MARIA CA
93455-6819
US

V. Phone/Fax

Practice location:
  • Phone: 973-299-9954
  • Fax:
Mailing address:
  • Phone: 805-979-9941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: