Provider Demographics
NPI:1366623969
Name:MARIO B RAMOS M D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARIO B RAMOS M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:BAENS
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-320-4431
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:760-416-7236
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:760-416-7236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60764261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1754236Medicaid
CAP00159661OtherRAILROAD MEDICARE B
CAF62344Medicare UPIN
CA222299952Medicare PIN