Provider Demographics
NPI:1972635431
Name:GEMULLA, TRISHA LEE (MBA, MS)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:LEE
Last Name:GEMULLA
Suffix:
Gender:F
Credentials:MBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 MUIR WAY
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-9678
Mailing Address - Country:US
Mailing Address - Phone:916-791-6002
Mailing Address - Fax:
Practice Address - Street 1:1130 LINCOLN WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5122
Practice Address - Country:US
Practice Address - Phone:916-300-4351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48197106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9892Medicare ID - Type UnspecifiedPRIVATE PROVIDER NUMBER