Healthcare Provider Details

I. General information

NPI: 1780162289
Provider Name (Legal Business Name): GABRIELLA KATHLEEN KUEBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3978 SORRENTO VALLEY BLVD STE 100
SAN DIEGO CA
92121-1436
US

IV. Provider business mailing address

2259 WIND RIVER RD
EL CAJON CA
92019-4142
US

V. Phone/Fax

Practice location:
  • Phone: 858-353-7723
  • Fax:
Mailing address:
  • Phone: 928-550-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: