Provider Demographics
NPI:1891200614
Name:RAMOS GALAVIZ, CLARISSA (NP)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:RAMOS GALAVIZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:
Other - Last Name:RAMOS-GALAVIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6680 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4126
Mailing Address - Country:US
Mailing Address - Phone:909-904-7113
Mailing Address - Fax:
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-835-7946
Practice Address - Fax:909-363-7447
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007311363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner