Provider Demographics
NPI:1801160056
Name:RAMOS, GEORGE L (LMT, HHP)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:L
Last Name:RAMOS
Suffix:
Gender:M
Credentials:LMT, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 LA POBLANA RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107
Mailing Address - Country:US
Mailing Address - Phone:505-750-1498
Mailing Address - Fax:
Practice Address - Street 1:1204 LA POBLANA RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1006
Practice Address - Country:US
Practice Address - Phone:505-750-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 175L00000X
NM7121225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No175L00000XOther Service ProvidersHomeopath