Healthcare Provider Details

I. General information

NPI: 1093274623
Provider Name (Legal Business Name): GABRIELLE THOMASON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9888 CARMEL MOUNTAIN RD STE J
SAN DIEGO CA
92129-2807
US

IV. Provider business mailing address

3070 MADISON ST
CARLSBAD CA
92008-2310
US

V. Phone/Fax

Practice location:
  • Phone: 858-207-4481
  • Fax: 858-216-8496
Mailing address:
  • Phone: 760-434-6100
  • Fax: 760-434-4583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number296373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: