MEDICARE: GABRIELE AESTHETICS

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1669619532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GABRIELE AESTHETICS

Provider Business Mailing Address
First Line	:	PO BOX 515802
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90051-3102
Country	:	US
Telephone Number	:	909-493-3800
Fax Number	:	909-204-7868

Provider Business Practice Location Address
First Line	:	473 N FAIR OAKS AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3621
Country	:	US
Telephone Number	:	626-792-2378
Fax Number	:	626-792-2605

Authorized Official
Title or Position	:	CEO
Name	:	DR. CLAYTON A VARGA
Credential	:	MD
Telephone Number	:	626-696-1400

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	05/24/2018

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