Provider Demographics
NPI:1508470303
Name:RAMIL, JIMMY CANOSA JR
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:CANOSA
Last Name:RAMIL
Suffix:JR
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 1:2514 CENTRAL AVE APT D
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4669
Mailing Address - Country:US
Mailing Address - Phone:209-483-0119
Mailing Address - Fax:
Practice Address - Street 1:2514 CENTRAL AVE APT D
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4669
Practice Address - Country:US
Practice Address - Phone:209-483-0119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2024-07-09
Deactivation Date:2021-08-24
Deactivation Code:
Reactivation Date:2024-06-18
Provider Licenses
StateLicense IDTaxonomies
CA36102111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty