Provider Demographics
NPI:1114029741
Name:RAMOS, CHARLYNNE-DIANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLYNNE-DIANNE
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RACE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3518
Mailing Address - Country:US
Mailing Address - Phone:408-278-3000
Mailing Address - Fax:
Practice Address - Street 1:2585 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4107
Practice Address - Country:US
Practice Address - Phone:408-278-3003
Practice Address - Fax:408-357-1265
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18003363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P84883Medicare UPIN