Provider Demographics
NPI:1639646540
Name:DE RAMOS, ANDREW BAYANI
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BAYANI
Last Name:DE RAMOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4099 N MISSION RD STE A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-2697
Mailing Address - Country:US
Mailing Address - Phone:323-221-1746
Mailing Address - Fax:
Practice Address - Street 1:4099 N MISSION RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-2697
Practice Address - Country:US
Practice Address - Phone:323-221-1746
Practice Address - Fax:323-221-5176
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
96335101YM0800X
CA96335101YM0800X, 1041C0700X
CAASW963351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health