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General NPI Number Information
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NPI Number | 1922631480
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Entity Type | Individual
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Provider Name | RAMIN LAIL FNP
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Gender | Male
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 1908 COFFEE RD STE 3
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City | MODESTO
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State | CA
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Zip | 95355-2719
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Country | US
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Telephone | 209-846-9429
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Fax |
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Provider Business Mailing Address
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Address Line | 1159 HEARTLAND DR
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City | MANTECA
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State | CA
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Zip | 95337-7952
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Country | US
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Telephone | 510-299-2702
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95013384
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License Number State | CA
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