Provider Demographics
NPI:1760974612
Name:RAMIREZ, ROY THOMAS III (BA)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:THOMAS
Last Name:RAMIREZ
Suffix:III
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47940 ARABIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-6828
Mailing Address - Country:US
Mailing Address - Phone:760-863-8177
Mailing Address - Fax:
Practice Address - Street 1:47940 ARABIA ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-6828
Practice Address - Country:US
Practice Address - Phone:760-863-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA144223OtherPROBATION