Provider Demographics
NPI:1639613037
Name:RAMIREZ, RANDY (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7909 FREDERICKSBURG RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3400
Mailing Address - Country:US
Mailing Address - Phone:210-614-4544
Mailing Address - Fax:210-679-3712
Practice Address - Street 1:5414 FREDERICKSBURG RD STE 100A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3641
Practice Address - Country:US
Practice Address - Phone:210-468-0800
Practice Address - Fax:210-733-8649
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132718363LA2100X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8858MBOtherBCBS
TX368977001Medicaid
TX8858MBOtherBCBS