Provider Demographics
NPI:1598432320
Name:GULRAIZ, ANAM (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ANAM
Middle Name:
Last Name:GULRAIZ
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 MACARTHUR BLVD STE A-2285
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2059
Mailing Address - Country:US
Mailing Address - Phone:310-926-5723
Mailing Address - Fax:
Practice Address - Street 1:4533 MACARTHUR BLVD STE A-2285
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2059
Practice Address - Country:US
Practice Address - Phone:310-926-5723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-28
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017542363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty