Provider Demographics
NPI:1043677875
Name:RAMOS, BETHANY L
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:L
Last Name:RAMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 TERRA NOVA BLVD
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3615
Mailing Address - Country:US
Mailing Address - Phone:512-470-4228
Mailing Address - Fax:
Practice Address - Street 1:1432 TERRA NOVA BLVD
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3615
Practice Address - Country:US
Practice Address - Phone:512-470-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11518116103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst