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General NPI Number Information
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NPI Number | 1114261617
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Entity Type | Individual
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Provider Name | JESSICA LARAE RAMON IDC
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Gender | Female
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 1 JARRETT WHITE RD CLB-3 MCBH
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City | TRIPLER ARMY MEDICAL CENTER
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State | HI
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Zip | 96859-5001
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Country | US
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Telephone | 808-257-1571
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 63062
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City | MCBH KANEOHE BAY
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State | HI
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Zip | 96863-3062
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Country | US
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Telephone | 808-257-1571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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