Provider Demographics
NPI:1720281686
Name:RAMOS, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:RAMOS
Suffix:
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 1:29435 FALLING LEAF DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-7271
Mailing Address - Country:US
Mailing Address - Phone:951-245-1953
Mailing Address - Fax:
Practice Address - Street 1:16480 HARBOR BLVD STE 103
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1361
Practice Address - Country:US
Practice Address - Phone:714-418-9606
Practice Address - Fax:714-418-1575
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA952815615171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator