Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 55651 | CA |
Y | 213EG0000X | General Practice | 55651 | CA |
NPI | 1003126343 |
---|---|
Provider Name | Jose Ruben Ramirez SR. |
First Address | Ontario, CA 91762-3218 |
Second Address | Ontario, CA 91762-3218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2010 |
Last Update Date | 20/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
261279944 | DENTAL (01) | CA |