Provider Demographics
NPI:1639420235
Name:RAMOS, ELLAINE BAGAMASBAD
Entity Type:Individual
Prefix:MS
First Name:ELLAINE
Middle Name:BAGAMASBAD
Last Name:RAMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ELLAINE
Other - Middle Name:BAGAMASBAD
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:PO BOX 1798
Mailing Address - Street 2:
Mailing Address - City:COLMA
Mailing Address - State:CA
Mailing Address - Zip Code:94014-1798
Mailing Address - Country:US
Mailing Address - Phone:650-296-8252
Mailing Address - Fax:
Practice Address - Street 1:2675 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3325
Practice Address - Country:US
Practice Address - Phone:415-845-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 76321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist