MEDICARE: JOSE RUBEN RAMIREZ SR. D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	55651	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	261279944	OTHER	CA	DENTAL

General Provider Information

NPI Number	:	1003126343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE RUBEN RAMIREZ SR. D.D.S.

Provider Business Mailing Address
First Line	:	524 N PALM AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-3218
Country	:	US
Telephone Number	:	909-467-2039
Fax Number	:	909-467-2052

Provider Business Practice Location Address
First Line	:	524 N PALM AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-3218
Country	:	US
Telephone Number	:	909-467-2039
Fax Number	:	909-467-2052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	12/20/2019

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