Provider Demographics
NPI:1730667486
Name:RAMOS PINEDA, IRIS YAMILETH (SA-C)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:YAMILETH
Last Name:RAMOS PINEDA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 STOCKER ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2428
Mailing Address - Country:US
Mailing Address - Phone:804-243-1849
Mailing Address - Fax:
Practice Address - Street 1:2177 STOCKER ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2428
Practice Address - Country:US
Practice Address - Phone:804-243-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17-335246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant