Provider Demographics
NPI:1417656992
Name:LARA, GISSELLE (FNP)
Entity type:Individual
Prefix:
First Name:GISSELLE
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:234 E BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2115
Mailing Address - Country:US
Mailing Address - Phone:626-915-9992
Mailing Address - Fax:626-410-1121
Practice Address - Street 1:10251 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6719
Practice Address - Country:US
Practice Address - Phone:562-867-8681
Practice Address - Fax:562-866-5198
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95022684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily