Healthcare Provider Details

I. General information

NPI: 1316402027
Provider Name (Legal Business Name): SARAH GEBRAIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9451 STONEYBROCK PL
RANCHO CUCAMONGA CA
91730-7970
US

IV. Provider business mailing address

9451 STONEYBROCK PL
RANCHO CUCAMONGA CA
91730-7970
US

V. Phone/Fax

Practice location:
  • Phone: 201-238-3023
  • Fax:
Mailing address:
  • Phone: 201-238-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: