Provider Demographics
NPI:1649704057
Name:RAMIREZ, ADRIAN (BA)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:ADRIAN
Other - Middle Name:JOSUE
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2115 S BRODEN ST APT B
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-5248
Mailing Address - Country:US
Mailing Address - Phone:714-342-7481
Mailing Address - Fax:
Practice Address - Street 1:12440 FIRESTONE BLVD
Practice Address - Street 2:SUITE 3020
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4328
Practice Address - Country:US
Practice Address - Phone:562-864-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390200000XOtherSTUDENT IN AN ORGANIZED HEALTH CARE EDUCATION/TRAINING PROGRAM