Provider Demographics
NPI:1396202487
Name:RAMIREZ, GRACIELA (BS)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 N ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3745
Mailing Address - Country:US
Mailing Address - Phone:714-727-7053
Mailing Address - Fax:
Practice Address - Street 1:3303 HARBOR BLVD STE B8
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1517
Practice Address - Country:US
Practice Address - Phone:714-786-6069
Practice Address - Fax:714-834-9822
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician