Provider Demographics
NPI:1104589126
Name:RAMIREZ, CHONA C
Entity type:Individual
Prefix:MRS
First Name:CHONA
Middle Name:C
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHONA
Other - Middle Name:RONDILLA
Other - Last Name:CRISOSTOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHONA CRISOSTOMO
Mailing Address - Street 1:15801 S 48TH ST APT 2019
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0826
Mailing Address - Country:US
Mailing Address - Phone:775-671-7446
Mailing Address - Fax:
Practice Address - Street 1:15801 S 48TH ST APT 2019
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0826
Practice Address - Country:US
Practice Address - Phone:775-671-7446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-17
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246RP1900X
AZ23280951246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1104589126Other1104589126
AZ1104589126Medicaid