Healthcare Provider Details

I. General information

NPI: 1760210876
Provider Name (Legal Business Name): SOZANA GBRAAEL JR.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 BARCELONA WAY
UNION CITY CA
94587-4701
US

IV. Provider business mailing address

4651 BARCELONA WAY
UNION CITY CA
94587-4701
US

V. Phone/Fax

Practice location:
  • Phone: 510-938-2289
  • Fax:
Mailing address:
  • Phone: 510-938-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number202357911123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: