1588628135 NPI number — JASMIN GRACE VALERA RAMIREZ RD LD CDE

Table of content: JASMIN GRACE VALERA RAMIREZ RD LD CDE (NPI 1588628135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588628135 NPI number — JASMIN GRACE VALERA RAMIREZ RD LD CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMIREZ
Provider First Name:
JASMIN
Provider Middle Name:
GRACE VALERA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD LD CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VALERA
Provider Other First Name:
JASMIN
Provider Other Middle Name:
GRACE PAGUYO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD LD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588628135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7701 YORK AVE S
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-5845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-927-7810
Provider Business Mailing Address Fax Number:
952-927-6309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7701 YORK AVE S
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-5845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-927-7810
Provider Business Practice Location Address Fax Number:
952-927-6309
Provider Enumeration Date:
04/12/2006

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: 133VN1006X , with the licence number:  2364 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HP41069 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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