Healthcare Provider Details

I. General information

NPI: 1003440470
Provider Name (Legal Business Name): MARIANNA HELEN GABRIEL RD CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 ALTON PKWY
IRVINE CA
92618-3734
US

IV. Provider business mailing address

1 PALACIO
RANCHO SANTA MARGARITA CA
92688-3440
US

V. Phone/Fax

Practice location:
  • Phone: 949-932-6734
  • Fax:
Mailing address:
  • Phone: 949-439-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number11815
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: