Provider Demographics
NPI:1740055581
Name:RAMSEY, BENITA ANNETTE
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:ANNETTE
Last Name:RAMSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N D ST STE 429
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1522
Mailing Address - Country:US
Mailing Address - Phone:909-519-3927
Mailing Address - Fax:
Practice Address - Street 1:330 N D ST STE 429
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1522
Practice Address - Country:US
Practice Address - Phone:909-519-3927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker