Provider Demographics
NPI:1497820393
Name:VAN GELDER, LEILA (NP)
Entity Type:Individual
Prefix:MS
First Name:LEILA
Middle Name:
Last Name:VAN GELDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3805
Mailing Address - Country:US
Mailing Address - Phone:650-855-9922
Mailing Address - Fax:
Practice Address - Street 1:276 INTERNATIONAL CIRCLE
Practice Address - Street 2:KAISER PERMANENTE DEPT OBGYN
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119
Practice Address - Country:US
Practice Address - Phone:408-972-6266
Practice Address - Fax:408-972-6966
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308808363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP26575Medicare UPIN