Provider Demographics
NPI:1295061919
Name:RAYMUNDO, NICOLE KIRSTEN (RN)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:KIRSTEN
Last Name:RAYMUNDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:KIRSTEN
Other - Last Name:ROONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 MISSION AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7102
Mailing Address - Country:US
Mailing Address - Phone:760-967-4475
Mailing Address - Fax:760-966-3827
Practice Address - Street 1:1701 MISSION AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7102
Practice Address - Country:US
Practice Address - Phone:760-967-4475
Practice Address - Fax:760-966-3827
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA748985163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse