Basic Information
| Provider Information | |||||||||
| NPI: | 1568931384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMELLA | ||||||||
| FirstName: | RACHEL | ||||||||
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| Credential: | CCP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2753 E BROADWAY RD STE 101-454 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852041579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804596964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 946 N LOMA VIS | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852135425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806596964 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2018 | ||||||||
| LastUpdateDate: | 11/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 242T00000X | Y | Technologists, Technicians & Other Technical Service Providers | Perfusionist |
No ID Information.