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General NPI Number Information
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NPI Number | 1366063919
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Entity Type | Individual
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Provider Name | CLARISSA A RAMIREZ ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 99 SUPPORTING SERVICES RD., LOADING DOCK 2
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-1015
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Country | US
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Telephone | 618-650-2935
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Fax |
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Provider Business Mailing Address
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Address Line | 1544 W BREAKWELL ST
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City | TUCSON
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State | AZ
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Zip | 85746-3963
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Country | US
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Telephone | 202-485-9165
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 3252
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096.004995
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License Number State | IL
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