=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184464885
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REVELINE P. GOROSPE FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2024
-----------------------------------------------------
Last Update Date | 11/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 67 EVANS RD
-----------------------------------------------------
City | WOFFORD HEIGHTS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93285-9696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-376-2276
-----------------------------------------------------
Fax | 760-376-4801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 67 EVANS RD
-----------------------------------------------------
City | WOFFORD HEIGHTS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93285-9696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-376-2276
-----------------------------------------------------
Fax | 760-376-4801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95029594
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------