Provider Demographics
NPI:1821657503
Name:COTA, ISMAEL RAMIREZ (FNP)
Entity Type:Individual
Prefix:MR
First Name:ISMAEL
Middle Name:RAMIREZ
Last Name:COTA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37461 LIMELIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-6218
Mailing Address - Country:US
Mailing Address - Phone:661-429-5737
Mailing Address - Fax:
Practice Address - Street 1:41210 11TH ST W STE K
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1450
Practice Address - Country:US
Practice Address - Phone:661-947-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95011669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily