Provider Demographics
NPI:1215350236
Name:RAMIREZ, ISRAEL (LSA)
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16240 SAN PEDRO AVE LOT 67
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3002
Mailing Address - Country:US
Mailing Address - Phone:210-315-8777
Mailing Address - Fax:210-257-0700
Practice Address - Street 1:16240 SAN PEDRO AVE LOT 67
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3002
Practice Address - Country:US
Practice Address - Phone:210-315-8777
Practice Address - Fax:210-257-0700
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00641363AS0400X
TX147107246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12678962OtherCAQH
147107OtherNBSTSA BOARD CERTIFICATION