Provider Demographics
NPI:1962128561
Name:LERAMA, EMMANUEL SOKOLAYAMIE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:SOKOLAYAMIE
Last Name:LERAMA
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 JUNIPER RIDGE BLVD APT 218
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-9282
Mailing Address - Country:US
Mailing Address - Phone:909-609-4460
Mailing Address - Fax:
Practice Address - Street 1:05853 KERMAN
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630
Practice Address - Country:US
Practice Address - Phone:559-846-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95280439163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse