Provider Demographics
NPI:1639141278
Name:RAMOS, RENIE ANSAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RENIE
Middle Name:ANSAY
Last Name:RAMOS
Suffix:
Gender:F
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:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-0511
Mailing Address - Country:US
Mailing Address - Phone:909-946-7647
Mailing Address - Fax:909-981-3770
Practice Address - Street 1:360 E 7TH ST
Practice Address - Street 2:SUITE N
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6701
Practice Address - Country:US
Practice Address - Phone:909-946-7647
Practice Address - Fax:909-981-3770
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33236208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A3323600Medicaid
CA00A3323600Medicaid