Provider Demographics
NPI:1417061847
Name:RAMOS, VANGIE (RD)
Entity Type:Individual
Prefix:
First Name:VANGIE
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:VANGIE
Other - Middle Name:
Other - Last Name:RAMOS-TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:WHITERIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85941-0860
Mailing Address - Country:US
Mailing Address - Phone:928-338-3574
Mailing Address - Fax:
Practice Address - Street 1:200 WEST HOSPITAL DR.
Practice Address - Street 2:
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941-0860
Practice Address - Country:US
Practice Address - Phone:928-338-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
707736133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8HZF44Medicare ID - Type UnspecifiedCIBECUE
AZ8HZF32Medicare ID - Type UnspecifiedWHITERIVER