Provider Demographics
NPI:1720678832
Name:RAMIREZ, ANDRES MARIO (AUD)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:MARIO
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WONDER WORLD DR STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7558
Mailing Address - Country:US
Mailing Address - Phone:512-667-7921
Mailing Address - Fax:
Practice Address - Street 1:1320 WONDER WORLD DR STE 107
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7558
Practice Address - Country:US
Practice Address - Phone:512-667-7921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81105231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81105OtherSTATE LICENSE