Healthcare Provider Details

I. General information

NPI: 1710294558
Provider Name (Legal Business Name): GABRIELA DE LOS COBOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberCPL4279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: