Healthcare Provider Details

I. General information

NPI: 1376228452
Provider Name (Legal Business Name): GULNOZA RAZIKOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 CIVIC DR
WALNUT CREEK CA
94596-4101
US

IV. Provider business mailing address

21081 HIGHLANDER
LAKE FOREST CA
92630-7228
US

V. Phone/Fax

Practice location:
  • Phone: 925-999-1260
  • Fax:
Mailing address:
  • Phone: 609-815-4822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: