Provider Demographics
NPI:1962735217
Name:RAMOS, GIBRAN K (ND, LAC)
Entity type:Individual
Prefix:
First Name:GIBRAN
Middle Name:K
Last Name:RAMOS
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4110 SE HAWTHORNE BLVD # 178
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5246
Mailing Address - Country:US
Mailing Address - Phone:503-482-9092
Mailing Address - Fax:503-715-5789
Practice Address - Street 1:7477 SE 52ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-8206
Practice Address - Country:US
Practice Address - Phone:503-482-9092
Practice Address - Fax:503-715-5789
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150207171100000X
OR1821175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist