Provider Demographics
NPI:1467680694
Name:GESSIN, LEAH GILANA (PA)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:GILANA
Last Name:GESSIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:GILANA
Other - Last Name:KIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:P.O. BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6006
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:916-437-0578
Practice Address - Street 1:2725 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6006
Practice Address - Country:US
Practice Address - Phone:916-262-9440
Practice Address - Fax:916-262-9445
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20355363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA20355OtherSTATE LICENSE NUMBER
CAZZZ04773ZOtherGROUP PTAN