Healthcare Provider Details

I. General information

NPI: 1376662148
Provider Name (Legal Business Name): GABRIEL K COUSENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 HARSHAW AVE.
PATAGONIA AZ
85624
US

IV. Provider business mailing address

PO BOX 778
PATAGONIA AZ
85624-0778
US

V. Phone/Fax

Practice location:
  • Phone: 520-394-2520
  • Fax: 415-598-2409
Mailing address:
  • Phone: 520-394-2520
  • Fax: 415-528-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number030
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: