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General NPI Number Information
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NPI Number | 1053020479
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Entity Type | Individual
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Provider Name | GABRIELLA TAL AMIGE PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 525 JAMESTOWN ST STE 205
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1751
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Country | US
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Telephone | 215-750-0301
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Fax | 215-944-8971
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Provider Business Mailing Address
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Address Line | 817 N 3RD ST APT 401
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City | PHILADELPHIA
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State | PA
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Zip | 19123-2564
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Country | US
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Telephone | 301-466-0485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA064173
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License Number State | PA
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