Provider Demographics
NPI:1568248045
Name:GRIMALDO, GISELA ESMERALDA (NP)
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:ESMERALDA
Last Name:GRIMALDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10143 ARLETA AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-4438
Mailing Address - Country:US
Mailing Address - Phone:661-300-0713
Mailing Address - Fax:
Practice Address - Street 1:2720 W MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3034
Practice Address - Country:US
Practice Address - Phone:818-842-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025435363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner