MEDICARE: MS. BERTHA ALICIA RAMOS

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	1041C0700X	Clinical Social Worker	LCSW60542	CA

General Provider Information

NPI Number	:	1215052832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BERTHA ALICIA RAMOS

Provider Business Mailing Address
First Line	:	811 W 232ND ST UNIT C
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90502-2534
Country	:	US
Telephone Number	:	626-484-8909
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 W 9TH ST STE 103
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-3158
Country	:	US
Telephone Number	:	310-938-4575
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	02/18/2022

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