Healthcare Provider Details

I. General information

NPI: 1003258062
Provider Name (Legal Business Name): LANA C RAMOS RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WILSON ST
CLAYTON NM
88415-3304
US

IV. Provider business mailing address

400 HARDING ST APT 4
CLAYTON NM
88415-3339
US

V. Phone/Fax

Practice location:
  • Phone: 575-374-2585
  • Fax:
Mailing address:
  • Phone: 575-207-6387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4130
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: