Healthcare Provider Details

I. General information

NPI: 1003744988
Provider Name (Legal Business Name): VINCE GABRIEL GABORNO CADC1
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 AIRWAY AVE
COSTA MESA CA
92626-4607
US

IV. Provider business mailing address

10322 PARLIAMENT AVE
GARDEN GROVE CA
92840-1137
US

V. Phone/Fax

Practice location:
  • Phone: 714-766-5450
  • Fax:
Mailing address:
  • Phone: 714-766-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC146120125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: