Provider Demographics
NPI:1245010263
Name:IRAOLA, OFHELIA
Entity type:Individual
Prefix:
First Name:OFHELIA
Middle Name:
Last Name:IRAOLA
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 1:2324 FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-9216
Mailing Address - Country:US
Mailing Address - Phone:661-348-0532
Mailing Address - Fax:
Practice Address - Street 1:2324 FLORENCE DR
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-9216
Practice Address - Country:US
Practice Address - Phone:661-348-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty