Provider Demographics
NPI:1407335334
Name:RAMIREZ, SUZANNA
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17315 STUDEBAKER RD STE 300G
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2563
Mailing Address - Country:US
Mailing Address - Phone:562-210-8155
Mailing Address - Fax:562-309-9100
Practice Address - Street 1:17315 STUDEBAKER RD STE 300G
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2563
Practice Address - Country:US
Practice Address - Phone:562-210-8155
Practice Address - Fax:562-309-9100
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102-831089332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC1198612OtherDRIVERS LICENSE