Provider Demographics
NPI:1225725310
Name:RAMIREZ, IMELDA ISLA
Entity Type:Individual
Prefix:
First Name:IMELDA
Middle Name:ISLA
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 W CHAPMAN AVE APT 2105
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1740
Mailing Address - Country:US
Mailing Address - Phone:657-282-8359
Mailing Address - Fax:
Practice Address - Street 1:3063 W CHAPMAN AVE APT 2105
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1740
Practice Address - Country:US
Practice Address - Phone:657-282-8359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710207164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse