Provider Demographics
NPI:1962210575
Name:VIVAS RAMIREZ, JEAN CARLOS (SA-C)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:CARLOS
Last Name:VIVAS RAMIREZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 FAIRMOUNT DR APT 10-105
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1149
Mailing Address - Country:US
Mailing Address - Phone:854-213-3035
Mailing Address - Fax:
Practice Address - Street 1:8225 FAIRMOUNT DR APT 10-105
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1149
Practice Address - Country:US
Practice Address - Phone:854-213-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO003286246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant