Provider Demographics
NPI:1316259096
Name:RAMIREZ, JESSIE (AOS,CMT,CIMI)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:AOS,CMT,CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 PARK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5707
Mailing Address - Country:US
Mailing Address - Phone:916-509-0181
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY AVE
Practice Address - Street 2:100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6504
Practice Address - Country:US
Practice Address - Phone:916-437-0570
Practice Address - Fax:916-437-0470
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA346492225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist