Healthcare Provider Details

I. General information

NPI: 1851101497
Provider Name (Legal Business Name): KIMBERLY SIGUENZA-RAMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 SW 4TH AVE STE 105
ONTARIO OR
97914-2638
US

IV. Provider business mailing address

840 SW 4TH AVE STE 105
ONTARIO OR
97914-2638
US

V. Phone/Fax

Practice location:
  • Phone: 541-881-2800
  • Fax:
Mailing address:
  • Phone: 541-881-2800
  • Fax: 541-881-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA230581
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1781806
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: