Healthcare Provider Details

I. General information

NPI: 1720052541
Provider Name (Legal Business Name): SYLVIA A GISI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31493 RANCHO PUEBLO SUITE 204
TEMECULA CA
92592-4833
US

IV. Provider business mailing address

31493 RANCHO PUEBLO RD SUITE 204
TEMECULA CA
92592-4833
US

V. Phone/Fax

Practice location:
  • Phone: 951-303-6158
  • Fax: 951-303-8492
Mailing address:
  • Phone: 951-303-6158
  • Fax: 951-303-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA75954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: