Provider Demographics
NPI:1326516717
Name:RAMIREZ, RUEL DECASTRO JR (PA-C)
Entity Type:Individual
Prefix:
First Name:RUEL
Middle Name:DECASTRO
Last Name:RAMIREZ
Suffix:JR
Gender:M
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 1:17100 NORWALK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2750
Mailing Address - Country:US
Mailing Address - Phone:562-860-2111
Mailing Address - Fax:
Practice Address - Street 1:17100 NORWALK BLVD BLDG SUITE101
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2750
Practice Address - Country:US
Practice Address - Phone:562-860-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA56230363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant