Healthcare Provider Details

I. General information

NPI: 1104414838
Provider Name (Legal Business Name): GABRIELLA REED TROGGIO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11840 S LA CIENEGA BLVD
HAWTHORNE CA
90250-3459
US

IV. Provider business mailing address

383 16TH PL UNIT A
COSTA MESA CA
92627-3203
US

V. Phone/Fax

Practice location:
  • Phone: 424-269-3400
  • Fax: 310-882-5451
Mailing address:
  • Phone: 480-980-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number299367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: