MEDICARE: GUADALUPE CHABRIEL AGPCNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	95038130	CA

General Provider Information

NPI Number	:	1003773532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUADALUPE CHABRIEL AGPCNP

Provider Business Mailing Address
First Line	:	85 W 8TH ST APT 405
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5589
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 LYNCH CREEK WAY STE 3
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-2310
Country	:	US
Telephone Number	:	707-303-8350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/15/2026

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