Provider Demographics
NPI:1184035214
Name:ESTRADA RAMOS, HERICK
Entity Type:Individual
Prefix:
First Name:HERICK
Middle Name:
Last Name:ESTRADA RAMOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 E. FLAMINGO RD.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-9305
Mailing Address - Country:US
Mailing Address - Phone:702-385-9097
Mailing Address - Fax:
Practice Address - Street 1:1555 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5258
Practice Address - Country:US
Practice Address - Phone:702-385-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health