Healthcare Provider Details

I. General information

NPI: 1972017705
Provider Name (Legal Business Name): VICTORIA ROSE RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 W MONTANA ST
PASADENA CA
91103-1327
US

IV. Provider business mailing address

455 W MONTANA ST
PASADENA CA
91103-1327
US

V. Phone/Fax

Practice location:
  • Phone: 626-389-6300
  • Fax:
Mailing address:
  • Phone: 626-389-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberVN692973
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberNV692973
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN692973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: