Provider Demographics
NPI:1033698972
Name:ONTIVEROS, ILSE CAROLINA
Entity type:Individual
Prefix:
First Name:ILSE
Middle Name:CAROLINA
Last Name:ONTIVEROS
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 1:200 24TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-1804
Mailing Address - Country:US
Mailing Address - Phone:510-412-9200
Mailing Address - Fax:
Practice Address - Street 1:200 24TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1804
Practice Address - Country:US
Practice Address - Phone:415-529-0875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist