Healthcare Provider Details

I. General information

NPI: 1356650402
Provider Name (Legal Business Name): MRS. GABRIELLA LAUREN ROEMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 06/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 CATALINA
LAGUNA BEACH CA
92651-2748
US

IV. Provider business mailing address

23461 S POINTE DR SUITE 220
LAGUNA HILLS CA
92653-1547
US

V. Phone/Fax

Practice location:
  • Phone: 949-494-4311
  • Fax:
Mailing address:
  • Phone: 949-855-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF71124
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT93116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: