Provider Demographics
NPI:1861972838
Name:RAMIREZ, SALEM GRACEE (SA-C)
Entity type:Individual
Prefix:
First Name:SALEM
Middle Name:GRACEE
Last Name:RAMIREZ
Suffix:
Gender:F
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 1:117 N 21ST ST APT 8
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-5601
Mailing Address - Country:US
Mailing Address - Phone:571-241-2205
Mailing Address - Fax:
Practice Address - Street 1:117 N 21ST ST APT 8
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-5601
Practice Address - Country:US
Practice Address - Phone:571-241-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA18-219246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant