Healthcare Provider Details

I. General information

NPI: 1437097177
Provider Name (Legal Business Name): GABRIELLA MAZARIEGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 SPRING ST # B
PLACERVILLE CA
95667-4543
US

IV. Provider business mailing address

4457 TUCKER DR
FOLSOM CA
95630-6031
US

V. Phone/Fax

Practice location:
  • Phone: 559-381-2082
  • Fax:
Mailing address:
  • Phone: 559-381-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95114075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: