Provider Demographics
NPI:1881018513
Name:FARUZZI, GINA (FNP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:FARUZZI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 VIA ENTRADA
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6830
Mailing Address - Country:US
Mailing Address - Phone:805-358-2810
Mailing Address - Fax:
Practice Address - Street 1:4275 VIA ENTRADA
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6830
Practice Address - Country:US
Practice Address - Phone:805-358-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily