Healthcare Provider Details

I. General information

NPI: 1740100734
Provider Name (Legal Business Name): KRISTEN VIRAMONTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 BASELINE RD
LA VERNE CA
91750-2025
US

IV. Provider business mailing address

355 W BADILLO ST
COVINA CA
91723-1828
US

V. Phone/Fax

Practice location:
  • Phone: 909-971-8205
  • Fax:
Mailing address:
  • Phone: 626-634-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: