Provider Demographics
NPI:1053429449
Name:RANESES, ERIC MATALUBOS
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:MATALUBOS
Last Name:RANESES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 EISENHOWER DR APT 394
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-3614
Mailing Address - Country:US
Mailing Address - Phone:228-313-4724
Mailing Address - Fax:
Practice Address - Street 1:251 EISENHOWER DR APT 394
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3614
Practice Address - Country:US
Practice Address - Phone:228-313-4724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist