Provider Demographics
NPI:1417690975
Name:HETZEL RAMOS, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:HETZEL 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 1:2071 INGAMAC WAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-1258
Mailing Address - Country:US
Mailing Address - Phone:858-336-2862
Mailing Address - Fax:
Practice Address - Street 1:2071 INGAMAC WAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-1258
Practice Address - Country:US
Practice Address - Phone:858-336-2862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174400000XOther Service ProvidersSpecialist