Provider Demographics
NPI:1669824264
Name:BERRELLEZA, RAMONA (BA)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:
Last Name:BERRELLEZA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:BERRELLEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2358 UNIVERSITY AVE # 938
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2720
Mailing Address - Country:US
Mailing Address - Phone:760-908-5210
Mailing Address - Fax:
Practice Address - Street 1:2358 UNIVERSITY AVE # 938
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2720
Practice Address - Country:US
Practice Address - Phone:760-908-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)