Provider Demographics
NPI:1003024035
Name:RAMIREZ, MICHAEL MATTHEW (OTR)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MATTHEW
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11391 DAVENPORT RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3016
Mailing Address - Country:US
Mailing Address - Phone:562-400-9388
Mailing Address - Fax:562-370-1258
Practice Address - Street 1:11391 DAVENPORT RD
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3016
Practice Address - Country:US
Practice Address - Phone:562-400-9388
Practice Address - Fax:562-370-1258
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4760225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist