Provider Demographics
NPI:1851981542
Name:RAMOS GOMEZ, ZORYANA STEPANIVNA
Entity Type:Individual
Prefix:
First Name:ZORYANA
Middle Name:STEPANIVNA
Last Name:RAMOS GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CIRCLE CITY DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1642
Mailing Address - Country:US
Mailing Address - Phone:850-313-9371
Mailing Address - Fax:
Practice Address - Street 1:1400 CIRCLE CITY DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1642
Practice Address - Country:US
Practice Address - Phone:850-313-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17640OtherSTATE OF CALIFORNIA, DEPARTMENT OF CONSUMER AFFAIRS, OT BOARD