Healthcare Provider Details

I. General information

NPI: 1124281332
Provider Name (Legal Business Name): RICHMOND JOLONGBAYAN RAMIREZ MD, FAAFP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-2718
US

IV. Provider business mailing address

2405 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-2718
US

V. Phone/Fax

Practice location:
  • Phone: 702-960-4568
  • Fax: 855-592-1927
Mailing address:
  • Phone: 252-319-2607
  • Fax: 855-592-1927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20315
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT193198
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD13709
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number20315
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: