Healthcare Provider Details

I. General information

NPI: 1962336669
Provider Name (Legal Business Name): GISELLE GRAJEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 W HEALD AVE
LAKE ELSINORE CA
92530-3203
US

IV. Provider business mailing address

1511 W HEALD AVE
LAKE ELSINORE CA
92530-3203
US

V. Phone/Fax

Practice location:
  • Phone: 949-656-9271
  • Fax:
Mailing address:
  • Phone: 949-656-9271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number742112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: