Healthcare Provider Details

I. General information

NPI: 1881219707
Provider Name (Legal Business Name): GABRIELLE HUNGATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10754 N CHAPIN CT
TUCSON AZ
85737-6634
US

IV. Provider business mailing address

10754 N CHAPIN CT
TUCSON AZ
85737-6634
US

V. Phone/Fax

Practice location:
  • Phone: 619-971-3558
  • Fax:
Mailing address:
  • Phone: 619-971-3558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: