Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | A80016 | CA |
NPI | 1023185931 |
---|---|
Provider Name | Blanca E. Viramontes |
First Address | Fontana, CA 92335-6720 |
Second Address | Fontana, CA 92335-6720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 30/11/2021 |