Healthcare Provider Details

I. General information

NPI: 1992612048
Provider Name (Legal Business Name): VENICE YEM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 CAMINO RAMON
SAN RAMON CA
94583-4289
US

IV. Provider business mailing address

2613 CAMINO RAMON
SAN RAMON CA
94583-4289
US

V. Phone/Fax

Practice location:
  • Phone: 855-726-4764
  • Fax:
Mailing address:
  • Phone: 855-726-4764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number846051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: