Provider Demographics
NPI:1093942476
Name:STANLEY, GUADALUPE CEJA (PA-C)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:CEJA
Last Name:STANLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601
Mailing Address - Country:US
Mailing Address - Phone:510-535-4000
Mailing Address - Fax:510-535-4128
Practice Address - Street 1:2240 GLADSTONE DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565
Practice Address - Country:US
Practice Address - Phone:925-431-2100
Practice Address - Fax:925-431-1234
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20277363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant