Provider Demographics
NPI:1477164689
Name:GERARD-BUONOMO, RACHEL (DNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GERARD-BUONOMO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:GERARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1516 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2919
Mailing Address - Country:US
Mailing Address - Phone:619-823-5198
Mailing Address - Fax:
Practice Address - Street 1:4900 CALIFORNIA AVE STE 210B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7080
Practice Address - Country:US
Practice Address - Phone:310-963-0365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015098363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner