Provider Demographics
NPI:1801486352
Name:RAMOS, JESSICA NICOLE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:RAMOS
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 1:4470 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:GUADALUPE
Mailing Address - State:CA
Mailing Address - Zip Code:93434-1604
Mailing Address - Country:US
Mailing Address - Phone:805-304-9495
Mailing Address - Fax:
Practice Address - Street 1:1450 W MCCOY LN STE B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1059
Practice Address - Country:US
Practice Address - Phone:805-928-2200
Practice Address - Fax:805-928-6200
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77139183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician