Provider Demographics
NPI:1972207785
Name:RAMIREZ, GISELLE DENISE
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:DENISE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GISELLE
Other - Middle Name:
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15101 FAIRFIELD RANCH RD UNIT 6206
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-8874
Mailing Address - Country:US
Mailing Address - Phone:626-532-3316
Mailing Address - Fax:
Practice Address - Street 1:1343 N GRAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-4043
Practice Address - Country:US
Practice Address - Phone:626-389-9747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-23-64613103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst