Provider Demographics
NPI:1952180127
Name:RAMIREZ RAMIREZ, MARIELA
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:RAMIREZ RAMIREZ
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:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:CARNELIAN BAY
Mailing Address - State:CA
Mailing Address - Zip Code:96140-0399
Mailing Address - Country:US
Mailing Address - Phone:530-401-8242
Mailing Address - Fax:
Practice Address - Street 1:5225 N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:CARNELIAN BAY
Practice Address - State:CA
Practice Address - Zip Code:96140-1958
Practice Address - Country:US
Practice Address - Phone:530-401-8242
Practice Address - Fax:530-546-1939
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABBS113557104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker