Provider Demographics
NPI:1437481686
Name:RAIZ, JESUSA FERNANDEZ
Entity Type:Individual
Prefix:MS
First Name:JESUSA
Middle Name:FERNANDEZ
Last Name:RAIZ
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 1:96 LAKEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3724
Mailing Address - Country:US
Mailing Address - Phone:973-652-6865
Mailing Address - Fax:
Practice Address - Street 1:96 LAKEWOOD TER
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3724
Practice Address - Country:US
Practice Address - Phone:973-652-6865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY610874-1163W00000X
NJ26NR13574600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse