Healthcare Provider Details

I. General information

NPI: 1780004150
Provider Name (Legal Business Name): LISSETTE RAMIREZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 09/21/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 E HUNTING PARK AVE FL 2
PHILADELPHIA PA
19124-4800
US

IV. Provider business mailing address

1412-22 FAIRMOUNT AVENUE
PHILADELPHIA PA
19130-2908
US

V. Phone/Fax

Practice location:
  • Phone: 215-537-7695
  • Fax: 267-686-4071
Mailing address:
  • Phone: 215-684-5344
  • Fax: 215-232-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA056797
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: