Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 0401413513 | VA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 103920 | CA |
NPI | 1497014146 |
---|---|
Provider Name | Dr. Brent J Ramsey |
First Address | Valencia, CA 91355-1863 |
Second Address | Valencia, CA 91355-1863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2012 |
Last Update Date | 26/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0401413513 | LICENSE NUMBER (01) | VA |
103920 | LICENSE NUMBER (01) | CA |
12366116 | CAQH NUMBER (01) | |
FR1432789 | DEA NUMBER (01) |