Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 293794 | CA |
NPI | 1003016841 |
---|---|
Provider Name | Gizella Maria Raymond |
First Address | Morro Bay, CA 93442-1709 |
Second Address | Atascadero, CA 93422-5808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 19/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MR0948159 | DEA (01) | CA |