Provider Demographics
NPI:1053117291
Name:MIRAMONTES, ROSA ISABEL (CCMA)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:ISABEL
Last Name:MIRAMONTES
Suffix:
Gender:
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1796 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OLIVEHURST
Mailing Address - State:CA
Mailing Address - Zip Code:95961-4604
Mailing Address - Country:US
Mailing Address - Phone:530-301-9448
Mailing Address - Fax:
Practice Address - Street 1:1796 13TH ST
Practice Address - Street 2:
Practice Address - City:OLIVEHURST
Practice Address - State:CA
Practice Address - Zip Code:95961-4604
Practice Address - Country:US
Practice Address - Phone:530-301-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL7N2F2S5390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program