Provider Demographics
NPI:1922082478
Name:GURAVITZ, LISA (RN, MSN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:GURAVITZ
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 ASH AVE
Mailing Address - Street 2:SPC 25
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013-2240
Mailing Address - Country:US
Mailing Address - Phone:805-684-6587
Mailing Address - Fax:
Practice Address - Street 1:2921 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-5314
Practice Address - Country:US
Practice Address - Phone:805-487-5588
Practice Address - Fax:805-486-0038
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2944363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM18553HMedicaid
CAZZT40394FMedicaid
CANP0029440Medicaid
CARHM08609FMedicaid
CARHM08608FMedicaid