Healthcare Provider Details

I. General information

NPI: 1407201726
Provider Name (Legal Business Name): GABRIELA AMAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MARKET ST
RIVERSIDE CA
92501-1720
US

IV. Provider business mailing address

3877 12TH ST
RIVERSIDE CA
92501-3578
US

V. Phone/Fax

Practice location:
  • Phone: 951-247-6064
  • Fax: 951-242-6201
Mailing address:
  • Phone: 951-247-6064
  • Fax: 951-242-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: