Provider Demographics
NPI:1619344348
Name:GAMAD, MARICELLE LOPEZ (NP)
Entity Type:Individual
Prefix:
First Name:MARICELLE
Middle Name:LOPEZ
Last Name:GAMAD
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 1:2651 E SPICE WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4933
Mailing Address - Country:US
Mailing Address - Phone:559-441-3252
Mailing Address - Fax:209-550-5898
Practice Address - Street 1:2021 HERNDON AVE
Practice Address - Street 2:SUITE101
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6101
Practice Address - Country:US
Practice Address - Phone:559-797-4315
Practice Address - Fax:559-797-1651
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily