=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962636928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LILLY F RAMIREZ-BOYD, M.D., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2009
-----------------------------------------------------
Last Update Date | 02/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1140 W LA VETA AVE SUITE 410
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-4223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-285-0612
-----------------------------------------------------
Fax | 714-285-0618
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1140 W LA VETA AVE SUITE 410
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-4223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-285-0612
-----------------------------------------------------
Fax | 714-285-0618
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LILLY F RAMIREZ-BOYD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 714-285-0612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | G59399
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------