Provider Demographics
NPI:1154848638
Name:RAMIREZ, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:RAMIREZ
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 1:1157 LEMOYNE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3206
Mailing Address - Country:US
Mailing Address - Phone:213-483-6335
Mailing Address - Fax:213-483-9876
Practice Address - Street 1:1157 LEMOYNE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026
Practice Address - Country:US
Practice Address - Phone:213-483-6335
Practice Address - Fax:213-483-9876
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2022-11-28
Deactivation Date:2019-08-20
Deactivation Code:
Reactivation Date:2019-09-11
Provider Licenses
StateLicense IDTaxonomies
CA1121191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical