MEDICARE: JORGE LUIS RAMIREZ

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	376K00000X	Nurse's Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B12664145	OTHER	AZ	DL

General Provider Information

NPI Number	:	1467028779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE LUIS RAMIREZ

Provider Business Mailing Address
First Line	:	731 N 74TH ST
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-4307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	731 N 74TH ST
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-4307
Country	:	US
Telephone Number	:	862-800-6542
Fax Number	:

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

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	05/28/2021

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Directions to “ JORGE LUIS RAMIREZ ” Practice Location

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