Provider Demographics
NPI:1396191920
Name:RAMIREZ VALDES, RAFAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:RAMIREZ VALDES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 BERKELEY WAY APT 318
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-3258
Mailing Address - Country:US
Mailing Address - Phone:415-672-0093
Mailing Address - Fax:
Practice Address - Street 1:2232 ROAD 20
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3318
Practice Address - Country:US
Practice Address - Phone:510-236-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100174122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist