Provider Demographics
NPI:1972267979
Name:JARDON-RAMIREZ, ULISES
Entity Type:Individual
Prefix:
First Name:ULISES
Middle Name:
Last Name:JARDON-RAMIREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 MAXWELTON DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7940
Mailing Address - Country:US
Mailing Address - Phone:704-775-8460
Mailing Address - Fax:
Practice Address - Street 1:8101 MAXWELTON DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7940
Practice Address - Country:US
Practice Address - Phone:704-775-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program