Provider Demographics
NPI:1770624512
Name:RAMIREZ, JESSICA NINA (DC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:NINA
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12112 W WASHINGTON BLVD # 100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5514
Mailing Address - Country:US
Mailing Address - Phone:310-398-0636
Mailing Address - Fax:310-398-0546
Practice Address - Street 1:12112 W WASHINGTON BLVD # 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5514
Practice Address - Country:US
Practice Address - Phone:310-398-0636
Practice Address - Fax:310-398-0546
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor