Healthcare Provider Details

I. General information

NPI: 1437988946
Provider Name (Legal Business Name): ADDIE CLAIRE GONWA RAMONDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FREEDOM LN
ALISO VIEJO CA
92656-5876
US

IV. Provider business mailing address

200 FREEDOM LN
ALISO VIEJO CA
92656-5876
US

V. Phone/Fax

Practice location:
  • Phone: 949-900-8600
  • Fax:
Mailing address:
  • Phone: 949-900-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95031090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: