Provider Demographics
NPI:1386200061
Name:RAMOS, LORENZO JR
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:
Last Name:RAMOS
Suffix:JR
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:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:HATCH
Mailing Address - State:NM
Mailing Address - Zip Code:87937-1303
Mailing Address - Country:US
Mailing Address - Phone:575-343-6467
Mailing Address - Fax:
Practice Address - Street 1:257 BIANES ST.
Practice Address - Street 2:
Practice Address - City:HATCH
Practice Address - State:NM
Practice Address - Zip Code:87937-0130
Practice Address - Country:US
Practice Address - Phone:575-343-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician