Individual
IVAN OMAR MIRAMONTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5625 KINGSLEY ST, MONTCLAIR, CA 91763-3948
(909) 984-3634
Mailing address
950 W D ST, ONTARIO, CA 91762-3026
(909) 984-3634
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
CA
Other
Enumeration date
11/20/2025
Last updated
11/20/2025
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