45D1033210 CLIA NUMBER - IVAN RAMIREZ, MD

Laboratory Demographics

CLIA Number: 45D1033210

Facility Name: IVAN RAMIREZ, MD

Facility Address:
9670 RANCH RD 12
WIMBERLEY, TX
ZIP 78676
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Facility Phone Number: 512 847-6789

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1053464008

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D1033210
LAB Type	Physician Office
Facility Name	IVAN RAMIREZ, MD
Street	9670 RANCH RD 12
City	WIMBERLEY
State	TX
ZIP	78676
Phone	512 847-6789
CertificateType	4
CertificateEffectiveDate	11/5/2022
CertificateExpirationDate	11/4/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024