Healthcare Provider Details

I. General information

NPI: 1669959557
Provider Name (Legal Business Name): GABRIELLE SPINOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17400 MONTEREY RD
MORGAN HILL CA
95037-7318
US

IV. Provider business mailing address

2731 BARLOW DR
CASTRO VALLEY CA
94546-3207
US

V. Phone/Fax

Practice location:
  • Phone: 408-773-6200
  • Fax:
Mailing address:
  • Phone: 203-610-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number18856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: