Basic Information
| Provider Information | |||||||||
| NPI: | 1003016841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYMOND | ||||||||
| FirstName: | GIZELLA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | N.P., R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2641 KOA AVE | ||||||||
| Address2: | |||||||||
| City: | MORRO BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934421709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057719050 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10333 EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | ATASCADERO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934225808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054683007 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2007 | ||||||||
| LastUpdateDate: | 07/19/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 293794 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | MR0948159 | 01 | CA | DEA | OTHER |