Healthcare Provider Details

I. General information

NPI: 1982339446
Provider Name (Legal Business Name): GABRIEL FRANCIS BEVENTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 LANGSDORF DR STE 200
FULLERTON CA
92831-3702
US

IV. Provider business mailing address

44526 KINGSTON DR
TEMECULA CA
92592-5622
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-9264
  • Fax:
Mailing address:
  • Phone: 951-283-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: