Healthcare Provider Details

I. General information

NPI: 1811138449
Provider Name (Legal Business Name): GABIA ALEJANDRA AMBROCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 03/29/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 ELM AVE
HOLTVILLE CA
92250-1636
US

IV. Provider business mailing address

812 ELM AVE
HOLTVILLE CA
92250-1636
US

V. Phone/Fax

Practice location:
  • Phone: 760-697-6523
  • Fax:
Mailing address:
  • Phone: 760-697-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: