Provider Demographics
NPI:1487486924
Name:GESELL, SANDY (PMH-NP)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:GESELL
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 ELM AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-3046
Mailing Address - Country:US
Mailing Address - Phone:323-613-5568
Mailing Address - Fax:
Practice Address - Street 1:1373 ELM AVE APT B
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-3046
Practice Address - Country:US
Practice Address - Phone:323-613-5568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030299363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health