Healthcare Provider Details

I. General information

NPI: 1518577014
Provider Name (Legal Business Name): RACHELLE BURLAZA REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 08/09/2020
Certification Date: 08/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GEORGE BAILEY DETENTION FACILITY 446 ALTA RD SUITE 5300
SAN DIEGO CA
92158-0001
US

IV. Provider business mailing address

1366 PERSHING RD
CHULA VISTA CA
91913-2515
US

V. Phone/Fax

Practice location:
  • Phone: 619-661-2789
  • Fax:
Mailing address:
  • Phone: 619-600-8184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number747712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: