MEDICARE: RAMONA BERRELLEZA BA

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

General Provider Information

NPI Number	:	1669824264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMONA BERRELLEZA BA

Provider Business Mailing Address
First Line	:	2358 UNIVERSITY AVE # 938
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2720
Country	:	US
Telephone Number	:	760-908-5210
Fax Number	:

Provider Business Practice Location Address
First Line	:	2358 UNIVERSITY AVE # 938
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2720
Country	:	US
Telephone Number	:	760-908-5210
Fax Number	:

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

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	07/07/2016

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