Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | C37515 | CA |
NPI | 1033282256 |
---|---|
Provider Name | Mr. Archimedes Ramirez |
First Address | Kentfield, CA 94904-1418 |
Second Address | Kentfield, CA 94904-1418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A36649 | (02) | CA |