Basic Information
| Provider Information | |||||||||
| NPI: | 1639646540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DE RAMOS | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | BAYANI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4099 N MISSION RD STE A | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900322697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232211746 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4099 N MISSION RD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900322697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232211746 | ||||||||
| FaxNumber: | 3232215176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2018 | ||||||||
| LastUpdateDate: | 03/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 96335 | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 96335 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | 96335 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.