MEDICARE: MR. ANTONIO D RAMIREZ PH.D., LPSC

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	103TC1900X	Counseling Psychologist	130686	TX

General Provider Information

NPI Number	:	1336489764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTONIO D RAMIREZ PH.D., LPSC

Provider Business Mailing Address
First Line	:	4603 MANITOU
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1835
Country	:	US
Telephone Number	:	210-416-8004
Fax Number	:	210-433-2778

Provider Business Practice Location Address
First Line	:	4603 MANITOU
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1835
Country	:	US
Telephone Number	:	210-416-8004
Fax Number	:	210-433-2778

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

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	02/21/2013

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