Healthcare Provider Details

I. General information

NPI: 1164124921
Provider Name (Legal Business Name): MITRA RAMEZANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 139TH ST
VANCOUVER WA
98686-2742
US

IV. Provider business mailing address

555 NW MITCHELL ST UNIT B
CAMAS WA
98607-2620
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-1985
  • Fax: 360-604-1604
Mailing address:
  • Phone: 425-236-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.70122154
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: