Provider Demographics
NPI:1740347996
Name:RAMIREZ, JOSE LUIS (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LUIS
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45825 HIGHWAY 96 EAST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81006
Mailing Address - Country:US
Mailing Address - Phone:719-549-5491
Mailing Address - Fax:
Practice Address - Street 1:45825 HIGHWAY 96 EAST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81006
Practice Address - Country:US
Practice Address - Phone:719-549-5491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO635363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant