Provider Demographics
NPI:1013485317
Name:RAMIREZ, GENESIS P (LMT)
Entity Type:Individual
Prefix:
First Name:GENESIS
Middle Name:P
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14751 N KELSEY ST STE 110
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1457
Mailing Address - Country:US
Mailing Address - Phone:360-219-3312
Mailing Address - Fax:360-507-8075
Practice Address - Street 1:14751 N KELSEY ST STE 110
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272
Practice Address - Country:US
Practice Address - Phone:360-219-9912
Practice Address - Fax:360-507-8075
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60853671225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist