Provider Demographics
NPI:1336623255
Name:RAMOS, ROBERT MARI GUERRERO
Entity type:Individual
Prefix:
First Name:ROBERT MARI
Middle Name:GUERRERO
Last Name:RAMOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1312
Mailing Address - Country:US
Mailing Address - Phone:909-444-9488
Mailing Address - Fax:
Practice Address - Street 1:1249 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1312
Practice Address - Country:US
Practice Address - Phone:909-444-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49397122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49397OtherLICENSE NO.