Provider Demographics
NPI:1508904558
Name:FLUELLEN, RAMONA LYNN
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:LYNN
Last Name:FLUELLEN
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 1:11150 GLENOAKS BLVD UNIT 75
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6635
Mailing Address - Country:US
Mailing Address - Phone:818-899-5493
Mailing Address - Fax:
Practice Address - Street 1:11150 GLENOAKS BLVD UNIT 75
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-6635
Practice Address - Country:US
Practice Address - Phone:818-899-5493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)