Provider Demographics
NPI:1760049712
Name:RAMIERZ DOMENECH, MARIANELA (L, AC)
Entity Type:Individual
Prefix:
First Name:MARIANELA
Middle Name:
Last Name:RAMIERZ DOMENECH
Suffix:
Gender:F
Credentials:L, AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21914 CAPROCK CANYON
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONION
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-787-6305
Mailing Address - Fax:
Practice Address - Street 1:1380 PANTHEON WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-787-6305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC1878171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist