Healthcare Provider Details

I. General information

NPI: 1992275424
Provider Name (Legal Business Name): CHELSEA RAMIREZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1510
US

IV. Provider business mailing address

601 MENAUL BLVD NE UNIT 603
ALBUQUERQUE NM
87107-1563
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-6812
  • Fax:
Mailing address:
  • Phone: 505-250-4707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2018-0096
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: