Provider Demographics
NPI:1962175158
Name:RAMIREZ MARQUEZ, ARNOLD JOSAFAT
Entity type:Individual
Prefix:
First Name:ARNOLD
Middle Name:JOSAFAT
Last Name:RAMIREZ MARQUEZ
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 1:18860 NORDHOFF ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3879
Mailing Address - Country:US
Mailing Address - Phone:657-242-2079
Mailing Address - Fax:
Practice Address - Street 1:18860 NORDHOFF ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3879
Practice Address - Country:US
Practice Address - Phone:657-242-2079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-20-110907106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician