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General NPI Number Information
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NPI Number | 1659984078
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Entity Type | Organization
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Legal Business Name | SAN GABRIEL CLINIC
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 3231 WARING CT STE B
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City | OCEANSIDE
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State | CA
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Zip | 92056-4510
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Country | US
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Telephone | 760-666-7405
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Fax | 760-666-7562
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Provider Business Mailing Address
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Address Line | 864 E QUINCY AVE
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City | FRESNO
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State | CA
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Zip | 93720-2107
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Country | US
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Telephone | 559-917-8615
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. EVETTE GABRIEL
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Credential | PA
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Telephone | 760-666-7405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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