1336280338 NPI number — DR. ANGEL RIVERA RAMOS DDS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336280338 NPI number — DR. ANGEL RIVERA RAMOS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMOS
Provider First Name:
ANGEL
Provider Middle Name:
RIVERA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1336280338
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2775 N ROADRUNNER PKWY
Provider Second Line Business Mailing Address:
APT 706
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88011-8112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-667-7546
Provider Business Mailing Address Fax Number:
575-525-9099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 EL PASEO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001-6024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-526-1721
Provider Business Practice Location Address Fax Number:
575-525-9099
Provider Enumeration Date:
02/11/2007

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: 1223G0001X , with the licence number:  046797 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01739133 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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