Healthcare Provider Details

I. General information

NPI: 1427996206
Provider Name (Legal Business Name): GAELLE NICOLE TCHOUMBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

7782 NORTHROP DR
RIVERSIDE CA
92508-6085
US

IV. Provider business mailing address

7782 NORTHROP DR
RIVERSIDE CA
92508-6085
US

V. Phone/Fax

Practice location:
  • Phone: 909-646-2404
  • Fax:
Mailing address:
  • Phone: 909-646-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number61295Z3
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: