Provider Demographics
NPI:1992031520
Name:RAMIREZ, VICTOR S (DA)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:S
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N COLONIA DE LAS PALMAS
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1311
Mailing Address - Country:US
Mailing Address - Phone:323-503-0504
Mailing Address - Fax:323-415-0675
Practice Address - Street 1:5162 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-3932
Practice Address - Country:US
Practice Address - Phone:323-415-6161
Practice Address - Fax:323-415-0675
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1801005091126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801005091OtherEVEREST COLLEGE