Healthcare Provider Details

I. General information

NPI: 1659415255
Provider Name (Legal Business Name): MR. CARLOS GABRIEL COS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W VICTORIA ST
COMPTON CA
90220-5804
US

IV. Provider business mailing address

11855 RIVES AVE
DOWNEY CA
90241-4738
US

V. Phone/Fax

Practice location:
  • Phone: 310-868-5379
  • Fax:
Mailing address:
  • Phone: 323-384-5569
  • Fax: 310-868-5397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: