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General NPI Number Information
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NPI Number | 1245052018
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Entity Type | Individual
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Provider Name | RAIZZA QUEEN BANIQUED ACODE FNP-BC, NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 11633 VICTORY BLVD STE 100
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3513
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Country | US
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Telephone | 888-530-4415
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Fax | 833-471-5322
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Provider Business Mailing Address
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Address Line | 11633 VICTORY BLVD STE 100
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3513
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Country | US
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Telephone | 888-530-4415
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Fax | 833-471-5322
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95032745
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License Number State | CA
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