Provider Demographics
NPI:1407466717
Name:RAMOS, ELIDA ANN
Entity Type:Individual
Prefix:
First Name:ELIDA
Middle Name:ANN
Last Name:RAMOS
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 1:3011 S FLORES ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-2634
Mailing Address - Country:US
Mailing Address - Phone:210-794-5040
Mailing Address - Fax:
Practice Address - Street 1:3011 S FLORES ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-2634
Practice Address - Country:US
Practice Address - Phone:210-794-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29086023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX512531083Medicaid
TX29086023OtherSTATE IDENTIFICATION