Healthcare Provider Details

I. General information

NPI: 1497366223
Provider Name (Legal Business Name): GISELLE MACIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 COLORADO AVE
TURLOCK CA
95382-2713
US

IV. Provider business mailing address

1574 E CANAL DR
TURLOCK CA
95380-4161
US

V. Phone/Fax

Practice location:
  • Phone: 209-342-7353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: