Healthcare Provider Details

I. General information

NPI: 1962312348
Provider Name (Legal Business Name): GABRIELA ALESSANDRA CASAGRANDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 AVENIDA DE LA MADRID
SAN YSIDRO CA
92173-1508
US

IV. Provider business mailing address

2557 HIGH TRAIL CT
CHULA VISTA CA
91914-4151
US

V. Phone/Fax

Practice location:
  • Phone: 619-428-4424
  • Fax:
Mailing address:
  • Phone: 619-414-3557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: