Provider Demographics
NPI:1063171056
Name:RAMOS, STACEY ANN
Entity type:Individual
Prefix:
First Name:STACEY ANN
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 W 5TH ST FL 26
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90071-2053
Mailing Address - Country:US
Mailing Address - Phone:888-725-7087
Mailing Address - Fax:
Practice Address - Street 1:333 CITY BLVD W FL 17
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5905
Practice Address - Country:US
Practice Address - Phone:888-725-7087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician