Provider Demographics
NPI:1518403450
Name:SUMINISTRADO, PATRICIA ANN LLAMAS RAMOS
Entity Type:Individual
Prefix:
First Name:PATRICIA ANN
Middle Name:LLAMAS RAMOS
Last Name:SUMINISTRADO
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 1:7312 CORBIN AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7312 CORBIN AVE
Practice Address - Street 2:UNIT B
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3404
Practice Address - Country:US
Practice Address - Phone:818-645-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004904363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care