Provider Demographics
NPI:1932623246
Name:TAMULA, GISELLE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:TAMULA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1337
Mailing Address - Country:US
Mailing Address - Phone:310-582-7433
Mailing Address - Fax:310-582-7495
Practice Address - Street 1:1301 20TH ST STE 150
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-582-7433
Practice Address - Fax:310-582-7495
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006195363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner