Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 34566 | CA |
NPI | 1225681158 |
---|---|
Provider Name | Raul Ramirez |
First Address | Fontana, CA 92335-4949 |
Second Address | Torrance, CA 90505-4716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2019 |
Last Update Date | 19/07/2019 |