Healthcare Provider Details

I. General information

NPI: 1205503778
Provider Name (Legal Business Name): GABRIELE LOFTUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18045 N 20TH DR
PHOENIX AZ
85023-1352
US

IV. Provider business mailing address

18045 N 20TH DR
PHOENIX AZ
85023-1352
US

V. Phone/Fax

Practice location:
  • Phone: 408-348-3454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001803
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: