MEDICARE: LIZETTE DE RAMOS O.D.

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	152W00000X	Optometrist	15045	CA

General Provider Information

NPI Number	:	1699181933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZETTE DE RAMOS O.D.

Provider Business Mailing Address
First Line	:	7320 CASE AVE
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-5034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19733 RINALDI ST
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-4143
Country	:	US
Telephone Number	:	818-832-4646
Fax Number	:

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

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	05/24/2019

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