Provider Demographics
NPI:1699257659
Name:RAMIREZ, KRIS MARCO BERNAL (MSW INTERN)
Entity type:Individual
Prefix:
First Name:KRIS MARCO
Middle Name:BERNAL
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 TELEGRAPH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1359
Mailing Address - Country:US
Mailing Address - Phone:510-923-0180
Mailing Address - Fax:510-923-0894
Practice Address - Street 1:6333 TELEGRAPH AVE STE 102
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1359
Practice Address - Country:US
Practice Address - Phone:510-923-0180
Practice Address - Fax:510-923-0894
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0111Medicaid