Provider Demographics
NPI:1871772020
Name:JASSO-RAMIREZ, MARTHA (ASW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:JASSO-RAMIREZ
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:GALLARZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:2204 NATIONAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113
Mailing Address - Country:US
Mailing Address - Phone:619-515-2355
Mailing Address - Fax:619-232-7011
Practice Address - Street 1:2204 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-3615
Practice Address - Country:US
Practice Address - Phone:619-515-2355
Practice Address - Fax:619-232-7011
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW157941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical