Provider Demographics
NPI:1104992684
Name:VIRAMONTES, PHILLIP D (MSNC, BSN, RN, PHN)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:D
Last Name:VIRAMONTES
Suffix:
Gender:M
Credentials:MSNC, BSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 DINWIDDIE ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2003
Mailing Address - Country:US
Mailing Address - Phone:310-668-3404
Mailing Address - Fax:
Practice Address - Street 1:7020 DINWIDDIE ST
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241
Practice Address - Country:US
Practice Address - Phone:310-668-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500770163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health