Provider Demographics
NPI:1366559429
Name:RAMOS, MARIO BAENS (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:BAENS
Last Name:RAMOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:560 S PASEO DOROTEA
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-1434
Mailing Address - Country:US
Mailing Address - Phone:760-320-4431
Mailing Address - Fax:760-416-7234
Practice Address - Street 1:560 S PASEO DOROTEA
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1434
Practice Address - Country:US
Practice Address - Phone:760-320-4431
Practice Address - Fax:760-416-7234
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2011-12-14
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Provider Licenses
StateLicense IDTaxonomies
CAA60764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00159661OtherRAILROAD MEDICARE B
CA1754236Medicaid
CA1754236Medicaid
CA222299952Medicare ID - Type Unspecified