Healthcare Provider Details

I. General information

NPI: 1598432320
Provider Name (Legal Business Name): ANAM GULRAIZ PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2021
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 BRISTOL ST FL 6
COSTA MESA CA
92626-7170
US

IV. Provider business mailing address

301 BAYVIEW CIR STE 104
NEWPORT BEACH CA
92660-2948
US

V. Phone/Fax

Practice location:
  • Phone: 714-386-9766
  • Fax: 714-475-3716
Mailing address:
  • Phone: 310-926-5723
  • Fax: 714-475-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95017542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: