Provider Demographics
NPI:1295591915
Name:RAMIREZ, ETHAN PAUL (LAC)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:PAUL
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 LUCY LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1114
Mailing Address - Country:US
Mailing Address - Phone:925-719-1594
Mailing Address - Fax:
Practice Address - Street 1:2970 HILLTOP MALL RD STE 105
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1948
Practice Address - Country:US
Practice Address - Phone:510-717-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19969171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist