Healthcare Provider Details

I. General information

NPI: 1275955262
Provider Name (Legal Business Name): NAZIFA PAILLET FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 STATION WAY 210
ARROYO GRANDE CA
93420-3359
US

IV. Provider business mailing address

2050 S BLOSSER RD
SANTA MARIA CA
93458-7310
US

V. Phone/Fax

Practice location:
  • Phone: 805-473-6201
  • Fax:
Mailing address:
  • Phone: 805-361-8028
  • Fax: 805-361-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: