Provider Demographics
NPI:1528563582
Name:GARSULA, LALAINE ABRAJANO (FNP)
Entity Type:Individual
Prefix:
First Name:LALAINE
Middle Name:ABRAJANO
Last Name:GARSULA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LALAINE
Other - Middle Name:SURLA
Other - Last Name:ABRAJANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1102 S ABEL ST APT 315
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-9041
Mailing Address - Country:US
Mailing Address - Phone:650-665-3010
Mailing Address - Fax:
Practice Address - Street 1:554 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123
Practice Address - Country:US
Practice Address - Phone:408-281-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008403363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner