Healthcare Provider Details

I. General information

NPI: 1295443927
Provider Name (Legal Business Name): GISELA JESSICA BARAJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18601 VALLEY BLVD
BLOOMINGTON CA
92316-1831
US

IV. Provider business mailing address

24382 TIERRA DE ORO ST
MORENO VALLEY CA
92553-3344
US

V. Phone/Fax

Practice location:
  • Phone: 909-546-7560
  • Fax:
Mailing address:
  • Phone: 951-897-7137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95214775
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: