=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851359327
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTOR RAMIREZ PHYSICIANS ASSISTANT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2006
-----------------------------------------------------
Last Update Date | 10/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17695 ARROW BLVD CLINICA MEDICA FAMILIAR
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92335-4041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-854-3790
-----------------------------------------------------
Fax | 909-854-3792
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17695 ARROW BLVD
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92335-4041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-854-3790
-----------------------------------------------------
Fax | 909-854-3792
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA15328
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA15328
-----------------------------------------------------
License Number State |
-----------------------------------------------------