Provider Demographics
NPI:1215659883
Name:VIRAMONTES, VIOLETA
Entity type:Individual
Prefix:MS
First Name:VIOLETA
Middle Name:
Last Name:VIRAMONTES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VIOLET
Other - Middle Name:
Other - Last Name:VIRAMONTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9340 E STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1563
Mailing Address - Country:US
Mailing Address - Phone:916-509-8198
Mailing Address - Fax:916-509-8199
Practice Address - Street 1:390 40TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2633
Practice Address - Country:US
Practice Address - Phone:510-613-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175T00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist