Provider Demographics
NPI:1265675425
Name:RAMIREZ, CECILIA ONTIVEROS
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:ONTIVEROS
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 1:5565 E LINDA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-8802
Mailing Address - Country:US
Mailing Address - Phone:520-378-2799
Mailing Address - Fax:
Practice Address - Street 1:5565 E LINDA VISTA DR
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-8802
Practice Address - Country:US
Practice Address - Phone:520-378-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ201613385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0000000000Medicaid