Provider Demographics
NPI:1831896885
Name:RAYMUNDO, MA ARIADNE DOMINGO
Entity type:Individual
Prefix:
First Name:MA ARIADNE
Middle Name:DOMINGO
Last Name:RAYMUNDO
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 1:580 BUENA VISTA AVE APT E
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2071
Mailing Address - Country:US
Mailing Address - Phone:510-927-8732
Mailing Address - Fax:
Practice Address - Street 1:580 BUENA VISTA AVE APT E
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2071
Practice Address - Country:US
Practice Address - Phone:510-927-8732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284218164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse