Healthcare Provider Details

I. General information

NPI: 1821752072
Provider Name (Legal Business Name): GABRIELLE KEANA CAPORASO MSN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GABRIELLE KEANA FOLEY

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92350-1716
US

IV. Provider business mailing address

616 E SUNSET DR N
REDLANDS CA
92373-6409
US

V. Phone/Fax

Practice location:
  • Phone: 760-953-0670
  • Fax:
Mailing address:
  • Phone: 909-558-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95036866
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95236691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: