Healthcare Provider Details

I. General information

NPI: 1144776048
Provider Name (Legal Business Name): GABRIELA ROJAS TUFINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 CRENSHAW BLVD STE 300
LOS ANGELES CA
90043-1200
US

IV. Provider business mailing address

3031 S VERMONT AVE
LOS ANGELES CA
90007-3033
US

V. Phone/Fax

Practice location:
  • Phone: 323-290-8360
  • Fax:
Mailing address:
  • Phone: 323-290-8360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120915
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: