Provider Demographics
NPI:1801367776
Name:RAMIREZ HERRERA, DOLORES (SA-C)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:RAMIREZ HERRERA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IMG
Mailing Address - Street 1:2565 GRAND CONCOURSE APT 5E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4607
Mailing Address - Country:US
Mailing Address - Phone:347-340-5451
Mailing Address - Fax:
Practice Address - Street 1:2565 GRAND CONCOURSE APT 5E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4607
Practice Address - Country:US
Practice Address - Phone:347-340-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-512246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant