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General NPI Number Information
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NPI Number | 1740453414
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Entity Type | Individual
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Provider Name | GEORGE RAMIREZ VELASQUEZ INDEPENDENT DUTY HM
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Gender | Male
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 3RDLARBN, H&S COMPANY, MEDICAL BAS MCGACC 29 PALMS, 1STMARDIVDET
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92278-1321
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Country | US
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Telephone | 760-830-6062
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Fax |
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Provider Business Mailing Address
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Address Line | 5553 BAILEYA AVE
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92277-1321
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Country | US
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Telephone | 760-367-5443
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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