Healthcare Provider Details

I. General information

NPI: 1972888279
Provider Name (Legal Business Name): LUPE MARIE RAMOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE STE 750
ORANGE CA
92868-4312
US

IV. Provider business mailing address

1010 W LA VETA AVE STE 750
ORANGE CA
92868-4312
US

V. Phone/Fax

Practice location:
  • Phone: 714-361-6600
  • Fax: 714-919-8804
Mailing address:
  • Phone: 714-361-6600
  • Fax: 714-919-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number573383
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number573383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: