Provider Demographics
NPI:1144247602
Name:RAMIREZ, GEORGINA (MFT)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 LA JOLLA VILLAGE DR
Mailing Address - Street 2:STE 301
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-457-0700
Mailing Address - Fax:858-623-9188
Practice Address - Street 1:4130 LA JOLLA VILLAGE DR
Practice Address - Street 2:STE 301
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-457-0700
Practice Address - Fax:858-623-9188
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36417106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC36417OtherMFC