Basic Information
| Provider Information | |||||||||
| NPI: | 1366052755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMOS | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | IVAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 COLORADO BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900411744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235432800 | ||||||||
| FaxNumber: | 3239781263 | ||||||||
| Practice Location | |||||||||
| Address1: | 456 E ORANGE GROVE BLVD STE 140 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911045235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267656010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2020 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.