Provider Demographics
NPI:1316710619
Name:MRIZO, GEMMA (CD(DONA))
Entity type:Individual
Prefix:
First Name:GEMMA
Middle Name:
Last Name:MRIZO
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 DENTON CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5339
Mailing Address - Country:US
Mailing Address - Phone:650-669-0776
Mailing Address - Fax:
Practice Address - Street 1:2028 DENTON CT
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5339
Practice Address - Country:US
Practice Address - Phone:650-669-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13129374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula