Healthcare Provider Details

I. General information

NPI: 1427315274
Provider Name (Legal Business Name): ELISEO RAMIREZ CPHT, BSIT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W LISA DR STE B
CHAPARRAL NM
88081-7458
US

IV. Provider business mailing address

418 S COUNTY LINE DR
CHAPARRAL NM
88081-7801
US

V. Phone/Fax

Practice location:
  • Phone: 915-694-4205
  • Fax: 575-824-8208
Mailing address:
  • Phone: 915-694-4205
  • Fax: 575-824-8208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT00004947
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License NumberCOMPTIA ANSP
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: