Healthcare Provider Details

I. General information

NPI: 1275855330
Provider Name (Legal Business Name): GABRIELA TINOCO MCLEAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GABRIELA TINOCO DANIELS DPT

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15301 WARREN SHINGLE RD
BEALE AFB CA
95903-1905
US

IV. Provider business mailing address

15301 WARREN SHINGLE RD
BEALE AFB CA
95903-1905
US

V. Phone/Fax

Practice location:
  • Phone: 530-634-4199
  • Fax:
Mailing address:
  • Phone: 530-634-2941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT35209
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number35209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: