Healthcare Provider Details

I. General information

NPI: 1730042573
Provider Name (Legal Business Name): ALICYN JASMIN DE LEON RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 RIVER BEND RD NW
SALEM OR
97304-2109
US

IV. Provider business mailing address

972 RIVER BEND RD NW
SALEM OR
97304-2109
US

V. Phone/Fax

Practice location:
  • Phone: 971-719-1438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number9727586
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: