Provider Demographics
NPI:1013293976
Name:GELLERT, JULIA ALISSE BRENTA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ALISSE BRENTA
Last Name:GELLERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 VAN NESS AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-6920
Mailing Address - Country:US
Mailing Address - Phone:415-600-1000
Mailing Address - Fax:
Practice Address - Street 1:1100 VAN NESS AVE FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6920
Practice Address - Country:US
Practice Address - Phone:415-600-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant