Provider Demographics
NPI:1922282565
Name:GIZAW, GELILA
Entity Type:Individual
Prefix:
First Name:GELILA
Middle Name:
Last Name:GIZAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 BANCROFT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2471
Mailing Address - Country:US
Mailing Address - Phone:510-577-7089
Mailing Address - Fax:510-577-7078
Practice Address - Street 1:7200 BANCROFT AVE STE 202
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2471
Practice Address - Country:US
Practice Address - Phone:510-577-7089
Practice Address - Fax:510-577-7078
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556425163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA61292OtherPHN
CA556425OtherRN