Healthcare Provider Details

I. General information

NPI: 1518713171
Provider Name (Legal Business Name): LIZET GARCIA RAMOS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 E TOMPKINS AVE STE 101
LAS VEGAS NV
89121-5466
US

IV. Provider business mailing address

1460 N BLAKE ST
ORANGE CA
92867-3701
US

V. Phone/Fax

Practice location:
  • Phone: 725-724-2005
  • Fax:
Mailing address:
  • Phone: 714-400-8751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04240512
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number878112
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: