Provider Demographics
NPI:1699105239
Name:GAMBIZA, ANESU (RN)
Entity type:Individual
Prefix:MRS
First Name:ANESU
Middle Name:
Last Name:GAMBIZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ANESU
Other - Middle Name:B
Other - Last Name:GAMBIZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1 BOSTON MEDICAL CTR PL
Mailing Address - Street 2:DOWLING NORTH,SUITE 5108
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2908
Mailing Address - Country:US
Mailing Address - Phone:617-638-7062
Mailing Address - Fax:617-638-7075
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:DOWLING NORTH,SUITE 5108
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-638-7062
Practice Address - Fax:617-638-7075
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204792163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse