MEDICARE: DR. JORGE OCTAVIO GABELA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A43360	CA

General Provider Information

NPI Number	:	1396770558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE OCTAVIO GABELA M.D.

Provider Business Mailing Address
First Line	:	6928 PETIT ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-3304
Country	:	US
Telephone Number	:	619-944-3577
Fax Number	:

Provider Business Practice Location Address
First Line	:	6928 PETIT ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-3304
Country	:	US
Telephone Number	:	619-944-3577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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