Provider Demographics
NPI:1255219820
Name:BLISSETT, GRACIELA GARCIA
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:GARCIA
Last Name:BLISSETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELLY
Other - Middle Name:GARCIA
Other - Last Name:BLISSETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10601 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4733
Mailing Address - Country:US
Mailing Address - Phone:888-602-7090
Mailing Address - Fax:
Practice Address - Street 1:21326 E CLOVERTON ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1910
Practice Address - Country:US
Practice Address - Phone:626-612-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker