Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1124152590 |
---|---|
Provider Name | Juan Lizardo Ramirez |
First Address | Ontario, CA 91762-2706 |
Second Address | Pasadena, CA 91107-6622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C014583 | DMH STAFF CODE (01) | CA |
ICAN693 | LACDMH STAFF CODE (01) | CA |