Provider Demographics
NPI:1851359327
Name:RAMIREZ, VICTOR (PHYSICIANS ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17695 ARROW BLVD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-4041
Mailing Address - Country:US
Mailing Address - Phone:909-854-3790
Mailing Address - Fax:909-854-3792
Practice Address - Street 1:17695 ARROW BLVD
Practice Address - Street 2:CLINICA MEDICA FAMILIAR
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4041
Practice Address - Country:US
Practice Address - Phone:909-854-3790
Practice Address - Fax:909-854-3792
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15328363A00000X
PA15328363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0099140Medicaid
CAGR0099140Medicaid