MEDICARE: MIKE RAMBARAN

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	49070	TX

General Provider Information

NPI Number	:	1891499760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKE RAMBARAN

Provider Business Mailing Address
First Line	:	7510 FM 1765
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-3672
Country	:	US
Telephone Number	:	832-547-9961
Fax Number	:

Provider Business Practice Location Address
First Line	:	7510 FM 1765
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-3672
Country	:	US
Telephone Number	:	832-547-9961
Fax Number	:

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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Directions to “ MIKE RAMBARAN ” Practice Location

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