Healthcare Provider Details

I. General information

NPI: 1013293976
Provider Name (Legal Business Name): JULIA ALISSE BRENTA GELLERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 VAN NESS AVE FL 3
SAN FRANCISCO CA
94109-6920
US

IV. Provider business mailing address

1100 VAN NESS AVE FL 3
SAN FRANCISCO CA
94109-6920
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-1000
  • Fax:
Mailing address:
  • Phone: 415-600-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: