Provider Demographics
NPI:1972888279
Name:RAMOS, LUPE MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:LUPE
Middle Name:MARIE
Last Name:RAMOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 W LA VETA AVE STE 750
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4312
Mailing Address - Country:US
Mailing Address - Phone:714-361-6600
Mailing Address - Fax:714-919-8804
Practice Address - Street 1:1010 W LA VETA AVE STE 750
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4312
Practice Address - Country:US
Practice Address - Phone:714-361-6600
Practice Address - Fax:714-919-8804
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA573383363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912919804OtherTYPE 2 NPI
CA573383OtherRN MEDICAL LICENSE
CA18250OtherNP CERTIFICATE NUMBER
CA1912919804Medicaid
CACG5665OtherRAILROAD MEDICARE GROUP PTAN
CAP01428528OtherRAILROAD MEDICARE PROVIDER PTAN
CA18250OtherNP CERTIFICATE NUMBER
CA1912919804Medicaid