Healthcare Provider Details

I. General information

NPI: 1023738655
Provider Name (Legal Business Name): GABRIELA JESSICA MORIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELA JESSICA GARCIA

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N RAYMOND AVE BLDG 2-7
PASADENA CA
91103-1819
US

IV. Provider business mailing address

2629 W VALLEY BLVD
ALHAMBRA CA
91803-1814
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-5920
  • Fax:
Mailing address:
  • Phone: 626-656-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: