Healthcare Provider Details

I. General information

NPI: 1689587511
Provider Name (Legal Business Name): GISELLE A. MCGRATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37045 MULLIGAN DR
BEAUMONT CA
92223-8080
US

IV. Provider business mailing address

350 W BROOKSIDE AVE
CHERRY VALLEY CA
92223-4073
US

V. Phone/Fax

Practice location:
  • Phone: 909-244-7662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberD6F94E879B
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: