Provider Demographics
NPI:1679919492
Name:GROSS, DAISY CAROLINA DIAZ (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:CAROLINA DIAZ
Last Name:GROSS
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1503
Mailing Address - Country:US
Mailing Address - Phone:650-497-8773
Mailing Address - Fax:650-498-2734
Practice Address - Street 1:730 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1503
Practice Address - Country:US
Practice Address - Phone:650-497-8773
Practice Address - Fax:650-498-2734
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily