Provider Demographics
NPI:1457660359
Name:RAMIREZ, RUDY MANUEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RUDY
Middle Name:MANUEL
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3810
Mailing Address - Country:US
Mailing Address - Phone:951-710-1030
Mailing Address - Fax:
Practice Address - Street 1:13355 GREEN MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-6229
Practice Address - Country:US
Practice Address - Phone:951-258-4089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20540363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical