Healthcare Provider Details

I. General information

NPI: 1043445893
Provider Name (Legal Business Name): DIANA JANE ESTIPONA GELACIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 ARDEN WAY
SACRAMENTO CA
95825-2015
US

IV. Provider business mailing address

1359 PINE ST
SAN FRANCISCO CA
94109-4807
US

V. Phone/Fax

Practice location:
  • Phone: 916-486-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number35603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: