1568050854 NPI number — MISS JESSICA RAMOS FROMM CAA

Table of content: MISS JESSICA RAMOS FROMM CAA (NPI 1568050854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568050854 NPI number — MISS JESSICA RAMOS FROMM CAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FROMM
Provider First Name:
JESSICA
Provider Middle Name:
RAMOS
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CAA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAMOS
Provider Other First Name:
JESSICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568050854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 840862
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-0862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-377-7638
Provider Business Mailing Address Fax Number:
303-780-0787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 E MAPLEWOOD AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-4727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-438-3999
Provider Business Practice Location Address Fax Number:
720-439-9500
Provider Enumeration Date:
01/04/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367H00000X , with the licence number:  ANT.0000141 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)