MEDICARE: ALYSSA MICHELE RAMIREZ PA-C

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	363A00000X	Physician Assistant	PA11337	TX

General Provider Information

NPI Number	:	1215451430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MICHELE RAMIREZ PA-C

Provider Business Mailing Address
First Line	:	2100 TWIN ELMS DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-5639
Country	:	US
Telephone Number	:	832-693-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	8808 CAMP BOWIE WEST BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-6028
Country	:	US
Telephone Number	:	817-569-5980
Fax Number	:

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

Provider Enumeration Date	:	07/30/2017
Last Update Date	:	07/30/2017

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