Healthcare Provider Details

I. General information

NPI: 1598513350
Provider Name (Legal Business Name): PAYTON B GABALDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date: 05/23/2024
Reactivation Date: 04/22/2026

III. Provider practice location address

1450 N LAKE AVE STE 150
PASADENA CA
91104-2388
US

IV. Provider business mailing address

1450 N LAKE AVE STE 150
PASADENA CA
91104-2388
US

V. Phone/Fax

Practice location:
  • Phone: 626-794-1161
  • Fax:
Mailing address:
  • Phone: 626-794-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number92743
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: