Provider Demographics
NPI:1043803174
Name:PLAZA, GISELLA XIANNE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:GISELLA
Middle Name:XIANNE
Last Name:PLAZA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:GISELLA
Other - Middle Name:
Other - Last Name:PANTANOSAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 FREEDOM LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-0001
Mailing Address - Country:US
Mailing Address - Phone:949-643-1050
Mailing Address - Fax:
Practice Address - Street 1:300 FREEDOM LN
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-0001
Practice Address - Country:US
Practice Address - Phone:949-643-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251G0304X
CA40059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics