Basic Information
| Provider Information | |||||||||
| NPI: | 1922109560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GISLA | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 PRAIRIE CITY RD | ||||||||
| Address2: | |||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956309594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163514800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 02/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A61317 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 066818 | 01 | CA | HEALTH NET | OTHER | 1144565 | 01 | CA | FIRST HEALTH | OTHER | 00A613170 | 05 | CA | MEDICAID | 5506596 | 01 | CA | AETNA | OTHER | MCMG127600 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 33015 | 01 | CA | INTERPLAN | OTHER | 5799756 | 01 | CA | CIGNA | OTHER | 000810343519 | 01 | CA | PHCS | OTHER | 90096783 | 01 | CA | PACIFICARE | OTHER | 00A613170 | 01 | CA | BLUE SHIELD | OTHER | 1089891 | 01 | CA | GREAT WEST | OTHER | 1788455 | 01 | CA | UNITED HEALTHCARE | OTHER | A61317 | 01 | CA | BLUE CROSS | OTHER |