Provider Demographics
NPI:1891407508
Name:HA, GISELLE
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:HA
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 1:8782 SALMON AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5017
Mailing Address - Country:US
Mailing Address - Phone:650-455-4354
Mailing Address - Fax:
Practice Address - Street 1:2704 E WILLOW ST
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2217
Practice Address - Country:US
Practice Address - Phone:562-490-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023675363LF0000X
CA851342163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care