Healthcare Provider Details

I. General information

NPI: 1144115601
Provider Name (Legal Business Name): RAMSES ALVARADO LOPEZ FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 W 4TH ST STE 100
POMONA CA
91766-1625
US

IV. Provider business mailing address

13925 INDIAN ST
MORENO VALLEY CA
92553-5718
US

V. Phone/Fax

Practice location:
  • Phone: 866-590-6411
  • Fax:
Mailing address:
  • Phone: 855-505-7467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: