Provider Demographics
NPI:1982285243
Name:RAMIREZ, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 DOROTHY ST # B
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3909
Mailing Address - Country:US
Mailing Address - Phone:619-757-0121
Mailing Address - Fax:
Practice Address - Street 1:1675 MORENA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3703
Practice Address - Country:US
Practice Address - Phone:619-275-8000
Practice Address - Fax:619-275-8004
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician