Provider Demographics
NPI:1043522428
Name:RAMOS, BRENDA (LICENSED)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12581 DALE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-4517
Mailing Address - Country:US
Mailing Address - Phone:714-679-2499
Mailing Address - Fax:
Practice Address - Street 1:11721 TELEGRAPH RD STE A
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-6835
Practice Address - Country:US
Practice Address - Phone:562-949-4807
Practice Address - Fax:562-949-4807
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35312167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician