Provider Demographics
NPI:1679636112
Name:RAMOS, ALAN (NP)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:RAMOS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4364
Mailing Address - Country:US
Mailing Address - Phone:650-573-2222
Mailing Address - Fax:
Practice Address - Street 1:3150 LENOX PARK BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4299
Practice Address - Country:US
Practice Address - Phone:901-273-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371484363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP0134310Medicaid
CAP00382690OtherRAILROAD MEDICARE
CANP0134310Medicaid
CAZZZ04512ZMedicare PIN