1386663862 NPI number — DR. LILLY F RAMIREZ-BOYD M.D.

Table of content: DR. LILLY F RAMIREZ-BOYD M.D. (NPI 1386663862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386663862 NPI number — DR. LILLY F RAMIREZ-BOYD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMIREZ-BOYD
Provider First Name:
LILLY
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386663862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 W LA VETA AVE
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-4223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-285-0612
Provider Business Mailing Address Fax Number:
714-285-0618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 W LA VETA AVE
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-285-0612
Provider Business Practice Location Address Fax Number:
714-285-0618
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G59399 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0087980 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1962636928 . This is a "NPI - CORPORATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 264300915 . This is a "TAX ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G593990 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G59399 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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