Provider Demographics
NPI:1407924145
Name:DEMOTICA, RICHELLE RAMIREZ (CRNA)
Entity type:Individual
Prefix:MRS
First Name:RICHELLE
Middle Name:RAMIREZ
Last Name:DEMOTICA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:RICHELLE
Other - Middle Name:MERCADO
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:520 E EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4414
Mailing Address - Country:US
Mailing Address - Phone:210-581-2823
Mailing Address - Fax:210-581-2836
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-539-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 60186795163W00000X
WAAP60272220367500000X
TXAP138885367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse