1215585641 NPI number — ANDREW ERIC RAMIREZ HIGH SCHOOL DIPLOMA

Table of content: ANDREW ERIC RAMIREZ HIGH SCHOOL DIPLOMA (NPI 1215585641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215585641 NPI number — ANDREW ERIC RAMIREZ HIGH SCHOOL DIPLOMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMIREZ
Provider First Name:
ANDREW
Provider Middle Name:
ERIC
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HIGH SCHOOL DIPLOMA
Provider Gender Code:
M

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:
1215585641
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6430 N BRENDA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92407-4040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-205-1222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8350 ARCHIBALD AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-3670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-434-8923
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2019

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: 106S00000X , 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)





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