Provider Demographics
NPI:1447060355
Name:LOAIZA, GISELLE
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:LOAIZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17555 CORKILL RD SPC 25
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92241-8322
Mailing Address - Country:US
Mailing Address - Phone:760-660-7396
Mailing Address - Fax:
Practice Address - Street 1:17555 CORKILL RD SPC 25
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92241-8322
Practice Address - Country:US
Practice Address - Phone:760-660-7396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker