Provider Demographics
NPI:1255873238
Name:RAMIREZ, GLADYS BELEN (FNP)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:BELEN
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:
Other - Last Name:GALLARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1060 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4027
Mailing Address - Country:US
Mailing Address - Phone:909-981-8904
Mailing Address - Fax:
Practice Address - Street 1:1060 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4027
Practice Address - Country:US
Practice Address - Phone:909-981-8904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily