Provider Demographics
NPI:1780232330
Name:RAMIREZ, VICTOR SAMUEL
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:SAMUEL
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S BON VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-4408
Mailing Address - Country:US
Mailing Address - Phone:909-930-6793
Mailing Address - Fax:
Practice Address - Street 1:1515 S BON VIEW AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-4408
Practice Address - Country:US
Practice Address - Phone:909-930-6793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113549106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist