Provider Demographics
NPI:1811298177
Name:GARY RAMELLI, M.D. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:GARY RAMELLI, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:RAMELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-432-3469
Mailing Address - Street 1:2888 LONG BEACH BLVD.
Mailing Address - Street 2:# 320
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-432-3469
Mailing Address - Fax:562-424-1013
Practice Address - Street 1:2888 LONG BEACH BLVD.
Practice Address - Street 2:# 320
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-432-3469
Practice Address - Fax:562-424-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-13687207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39060Medicare UPIN