Healthcare Provider Details

I. General information

NPI: 1568248045
Provider Name (Legal Business Name): GISELA ESMERALDA GRIMALDO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 W MAGNOLIA BLVD
BURBANK CA
91505-3034
US

IV. Provider business mailing address

10143 ARLETA AVE UNIT 1
ARLETA CA
91331-4438
US

V. Phone/Fax

Practice location:
  • Phone: 818-842-8000
  • Fax:
Mailing address:
  • Phone: 661-300-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95025435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: