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NPI Code Detail

MEDICARE: JOSEPH RANDOLPH GAVRANICH PMHNP-BC

MEDICARE: JOSEPH RANDOLPH GAVRANICH PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95037693CA

General Provider Information

NPI Number : 1093671240
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH RANDOLPH GAVRANICH PMHNP-BC
Provider Business Mailing Address
First Line : 2050 N TUSTIN AVE
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-7827
Country : US
Telephone Number : 714-617-2530
Fax Number :
Provider Business Practice Location Address
First Line : 1 PARK PLZ STE 600
Second Line :
City : IRVINE
State : CA
Zip : 92614-5987
Country : US
Telephone Number : 856-404-5284
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/31/2025
Last Update Date : 04/06/2026

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