Healthcare Provider Details

I. General information

NPI: 1558105494
Provider Name (Legal Business Name): YVETTE RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE
FONTANA CA
92335-6720
US

IV. Provider business mailing address

1139 E CENTRAL AVE
SAN BERNARDINO CA
92408-2604
US

V. Phone/Fax

Practice location:
  • Phone: 909-677-6089
  • Fax:
Mailing address:
  • Phone: 909-677-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN95299333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: