Provider Demographics
NPI:1376228452
Name:RAZIKOVA, GULNOZA
Entity Type:Individual
Prefix:
First Name:GULNOZA
Middle Name:
Last Name:RAZIKOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21081 HIGHLANDER
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7228
Mailing Address - Country:US
Mailing Address - Phone:609-815-4822
Mailing Address - Fax:
Practice Address - Street 1:1551 CIVIC DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4101
Practice Address - Country:US
Practice Address - Phone:925-999-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily