Provider Demographics
NPI:1144670217
Name:RAMOS, COURTNEY (DO)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:1551 BISHOP STREET, BLDG B
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4661
Practice Address - Country:US
Practice Address - Phone:805-543-2744
Practice Address - Fax:805-543-0539
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16200207K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCB405552OtherMEDICARE PTAN
CA1144670217Medicaid