Provider Demographics
NPI:1093959702
Name:RAMOS, BRENDA ROSE BASCONCILLO (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENDA ROSE
Middle Name:BASCONCILLO
Last Name:RAMOS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3700 DELTA FAIR BLVD STE L
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4075
Mailing Address - Country:US
Mailing Address - Phone:925-778-3288
Mailing Address - Fax:925-778-2410
Practice Address - Street 1:3700 DELTA FAIR BLVD STE L
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509
Practice Address - Country:US
Practice Address - Phone:925-778-3288
Practice Address - Fax:925-778-2410
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor