Provider Demographics
NPI:1477545531
Name:RAMOS, ENRIQUE (MD,)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:RAMOS
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 W REDONDO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3586
Mailing Address - Country:US
Mailing Address - Phone:310-538-9400
Mailing Address - Fax:310-538-0101
Practice Address - Street 1:1141 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3586
Practice Address - Country:US
Practice Address - Phone:310-538-9400
Practice Address - Fax:310-538-0101
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG30295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44368Medicare UPIN