Basic Information
| Provider Information | |||||||||
| NPI: | 1518333665 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CIBRIAN | ||||||||
| FirstName: | GABRIELA | ||||||||
| MiddleName: | LOURDES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 926 N SAN ANTONIO AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917622246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094388272 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1461 E COOLEY DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923243921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099806700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2015 | ||||||||
| LastUpdateDate: | 02/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF85543 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 111239 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.