Healthcare Provider Details

I. General information

NPI: 1306601950
Provider Name (Legal Business Name): GABRIEL LLAMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 LLEWELLYN AVE
CAMPBELL CA
95008-1940
US

IV. Provider business mailing address

408 VISTA DEL MAR DR
APTOS CA
95003-4832
US

V. Phone/Fax

Practice location:
  • Phone: 379-040-8379
  • Fax:
Mailing address:
  • Phone: 831-334-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: