Provider Demographics
NPI:1851303358
Name:RAMOS, MARIA CELESTE (PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CELESTE
Last Name:RAMOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3322
Mailing Address - Country:US
Mailing Address - Phone:605-721-1559
Mailing Address - Fax:
Practice Address - Street 1:2016 2ND AVE
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3322
Practice Address - Country:US
Practice Address - Phone:605-721-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0509363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P68983Medicare UPIN
SD8HC705Medicare ID - Type Unspecified