Healthcare Provider Details

I. General information

NPI: 1487519906
Provider Name (Legal Business Name): GABRIELLA NICOLE PRADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELLA NICOLE RODRIGUEZ

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 JENSEN AVE
SANGER CA
93657-2251
US

IV. Provider business mailing address

938 RYAN AVE
FOWLER CA
93625-9498
US

V. Phone/Fax

Practice location:
  • Phone: 559-875-3023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number714425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: