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Individual

DR. GISELLA LAVERNE SANDY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(951) 486-4175
Mailing address
PO BOX 287, RIVERSIDE, CA 92502-0287
(951) 486-4175

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A70697
CA
208600000X
Surgery Physician
DR-50308
CO
208600000X
Surgery Physician
M-13674
ID
208600000X
Surgery Physician
M-1845
GU
2086S0102X
Surgical Critical Care Physician
A70697
CA
2086S0127X
Trauma Surgery Physician
A70697
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00A706970
BLUE SHIELD OF CALIFORNIA
CA
05
00A706970
CA
05
58021736
CO
Enumeration date
06/05/2006
Last updated
07/22/2025
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