Healthcare Provider Details

I. General information

NPI: 1023245016
Provider Name (Legal Business Name): GABRIEL T GIZAW M.D, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MCCAIN BLVD NMRTU NORTH ISLAND
SAN DIEGO CA
92135-7046
US

IV. Provider business mailing address

PO BOX 357046
SAN DIEGO CA
92135-7046
US

V. Phone/Fax

Practice location:
  • Phone: 619-545-4263
  • Fax:
Mailing address:
  • Phone: 619-545-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number55676-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: