=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124152590
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUAN LIZARDO RAMIREZ AA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2555 E COLORADO BLVD SUITE 100-101
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91107-6622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-577-2261
-----------------------------------------------------
Fax | 626-577-2543
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 566 W H ST
-----------------------------------------------------
City | ONTARIO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91762-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-629-2400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225C00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------