Healthcare Provider Details

I. General information

NPI: 1295219798
Provider Name (Legal Business Name): RAYLENE DAWN CARGIULO RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S. GREENFIELD RD.
GILBERT AZ
85234
US

IV. Provider business mailing address

6319 E INDIGO ST
MESA AZ
85205-3668
US

V. Phone/Fax

Practice location:
  • Phone: 480-650-6385
  • Fax:
Mailing address:
  • Phone: 480-650-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN178682
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: