Provider Demographics
NPI:1225460553
Name:RAMON, MARIA VISTA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:VISTA
Last Name:RAMON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MRS
Other - First Name:MARIA ROWENA
Other - Middle Name:VISTA
Other - Last Name:RAMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:3055 WILSHIRE BLVD.
Mailing Address - Street 2:STE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1119
Mailing Address - Country:US
Mailing Address - Phone:213-383-0008
Mailing Address - Fax:213-389-0390
Practice Address - Street 1:3055 WILSHIRE BLVD.
Practice Address - Street 2:STE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1119
Practice Address - Country:US
Practice Address - Phone:213-383-0008
Practice Address - Fax:213-389-0390
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist