1386034114 NPI number — MRS. RAMONA ELAINA JARAMILLO LOPEZ

Table of content: MRS. RAMONA ELAINA JARAMILLO LOPEZ (NPI 1386034114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386034114 NPI number — MRS. RAMONA ELAINA JARAMILLO LOPEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
RAMONA
Provider Middle Name:
ELAINA JARAMILLO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386034114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1405 SPRUCE STREET
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-715-5040
Provider Business Mailing Address Fax Number:
951-784-4976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 SPRUCE ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92507-2464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-715-5040
Provider Business Practice Location Address Fax Number:
951-784-4976
Provider Enumeration Date:
02/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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