Healthcare Provider Details

I. General information

NPI: 1124681499
Provider Name (Legal Business Name): GABRIELA SIERRAVIGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 DOVE ST
NEWPORT BEACH CA
92660-2840
US

IV. Provider business mailing address

205 39TH ST
RICHMOND CA
94805-2212
US

V. Phone/Fax

Practice location:
  • Phone: 949-630-8290
  • Fax:
Mailing address:
  • Phone: 510-412-5930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: