Provider Demographics
NPI:1811066210
Name:RESA, RAMON (MD)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:RESA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-0580
Mailing Address - Country:US
Mailing Address - Phone:559-386-4500
Mailing Address - Fax:
Practice Address - Street 1:569 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3260
Practice Address - Country:US
Practice Address - Phone:559-781-9301
Practice Address - Fax:559-782-7639
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A404000Medicaid
CA00A404000Medicaid