MEDICARE: PABLITA RAMIREZ BSW LSAA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0175601	NM

General Provider Information

NPI Number	:	1164808838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PABLITA RAMIREZ BSW LSAA

Provider Business Mailing Address
First Line	:	PO BOX 171
Second Line	:	103 SWANNACK RD
City	:	MESQUITE
State	:	NM
Zip	:	88048-0171
Country	:	US
Telephone Number	:	575-386-1463
Fax Number	:

Provider Business Practice Location Address
First Line	:	2805 LAS VEGAS CT
Second Line	:	SUITE B
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-4108
Country	:	US
Telephone Number	:	575-522-5144
Fax Number	:

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

Provider Enumeration Date	:	08/05/2015
Last Update Date	:	08/05/2015

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