Healthcare Provider Details

I. General information

NPI: 1275427015
Provider Name (Legal Business Name): MAYRA RAMOS MELGOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N ALAMEDA ST
LOS ANGELES CA
90012-1804
US

IV. Provider business mailing address

7416 RUIDOSO WAY
BAKERSFIELD CA
93309-7639
US

V. Phone/Fax

Practice location:
  • Phone: 213-613-0630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95287806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: