Provider Demographics
NPI:1659540185
Name:DELVENTHAL-WONG, GISCELA LIZBELL (NP)
Entity Type:Individual
Prefix:MRS
First Name:GISCELA
Middle Name:LIZBELL
Last Name:DELVENTHAL-WONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GISELA
Other - Middle Name:LIZBELL
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1800 HARRISON ST, 7TH FL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3429
Mailing Address - Country:US
Mailing Address - Phone:510-625-4101
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:4131 GEARY BLVD #404
Practice Address - Street 2:
Practice Address - City:SAN FRACISCO
Practice Address - State:CA
Practice Address - Zip Code:94118
Practice Address - Country:US
Practice Address - Phone:415-833-4753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17969363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner