Provider Demographics
NPI:1376340414
Name:PAREDES, IRMA MICHELLE
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:MICHELLE
Last Name:PAREDES
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 1:483 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4113
Mailing Address - Country:US
Mailing Address - Phone:415-702-7012
Mailing Address - Fax:
Practice Address - Street 1:508 WESSEX WAY
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2709
Practice Address - Country:US
Practice Address - Phone:415-702-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91131225700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty