Provider Demographics
NPI:1669159828
Name:RAMOS, HOLLY MAY (LVN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MAY
Last Name:RAMOS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 BLACK DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-3427
Mailing Address - Country:US
Mailing Address - Phone:909-736-6521
Mailing Address - Fax:
Practice Address - Street 1:1345 BLACK DIAMOND DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3427
Practice Address - Country:US
Practice Address - Phone:909-736-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276639164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse