Provider Demographics
NPI:1376867655
Name:RAMIREZCONG, GARY ESTUARDO
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ESTUARDO
Last Name:RAMIREZCONG
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 1:117 W TUNNELL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4096
Mailing Address - Country:US
Mailing Address - Phone:805-614-4940
Mailing Address - Fax:805-614-0179
Practice Address - Street 1:117 W TUNNELL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4096
Practice Address - Country:US
Practice Address - Phone:805-614-4940
Practice Address - Fax:805-614-0179
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist