Healthcare Provider Details

I. General information

NPI: 1902506918
Provider Name (Legal Business Name): GULRAIZ MEDICAL AND PSYCHIATRIC NURSING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26632 TOWNE CENTRE DR STE 300
FOOTHILL RANCH CA
92610-2814
US

IV. Provider business mailing address

4199 CAMPUS DR STE 550
IRVINE CA
92612-4694
US

V. Phone/Fax

Practice location:
  • Phone: 949-620-6397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARYAM GULRAIZ
Title or Position: PRESIDENT
Credential: NP
Phone: 949-620-6397