Healthcare Provider Details

I. General information

NPI: 1225315906
Provider Name (Legal Business Name): GABRIELLA CALO SIEGEL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8549 WILSHIRE BLVD UNIT 3142
BEVERLY HILLS CA
90211-3104
US

IV. Provider business mailing address

547 WINCHESTER DR
OXNARD CA
93036-1464
US

V. Phone/Fax

Practice location:
  • Phone: 424-234-6169
  • Fax: 310-870-3812
Mailing address:
  • Phone: 424-234-6169
  • Fax: 310-870-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPSY 24517
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 24517
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 24517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: