Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1073144010 |
---|---|
Provider Name | Miss Melissa Alexis Ramirez |
First Address | San Ysidro, CA 92173-1976 |
Second Address | Chula Vista, CA 91913-2503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2020 |
Last Update Date | 29/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
680317191 | MEDCAL (01) | CA |
9611740AA | MEDICAL (01) | CA |