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General NPI Number Information
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NPI Number | 1962622803
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Entity Type | Organization
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Legal Business Name | WARREN REGH C. GABRILLO III M.D. INC.
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 631 N 13TH AVE A
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City | UPLAND
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State | CA
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Zip | 91786-4946
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Country | US
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Telephone | 909-982-2088
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Fax | 909-982-2058
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Provider Business Mailing Address
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Address Line | 631 N 13TH AVE A
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City | UPLAND
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State | CA
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Zip | 91786-4946
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Country | US
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Telephone | 909-982-2088
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Fax | 909-982-2058
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WARREN REGH CAMOTES GABRILLO III
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Credential | M.D.
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Telephone | 909-982-2088
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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 | A51794
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License Number State | CA
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