Provider Demographics
NPI:1699043257
Name:RAMIREZ, JASON RYAN (LVN)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:RYAN
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21551 BROOKHURST ST
Mailing Address - Street 2:APT 173
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-8007
Mailing Address - Country:US
Mailing Address - Phone:760-490-8732
Mailing Address - Fax:
Practice Address - Street 1:21551 BROOKHURST ST
Practice Address - Street 2:APT 173
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-8007
Practice Address - Country:US
Practice Address - Phone:760-490-8732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260390164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse