Healthcare Provider Details

I. General information

NPI: 1942322060
Provider Name (Legal Business Name): RODNEY A GABRIEL M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S. SAN VICENTE BLVD.
LOS ANGELES CA
90048
US

IV. Provider business mailing address

444 S. SAN VICENTE BLVD.
LOS ANGELES CA
90048
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-9788
  • Fax: 310-423-9958
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG56204
License Number StateCA

VIII. Authorized Official

Name: RONALD A GABRIEL
Title or Position: GENERAL
Credential:
Phone: 310-423-9788