Basic Information
| Provider Information | |||||||||
| NPI: | 1942459193 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GABAT-SIABABA | ||||||||
| FirstName: | JOSEPHINE | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 447 N EL MOLINO AVE | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911011403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265778480 | ||||||||
| FaxNumber: | 6265778978 | ||||||||
| Practice Location | |||||||||
| Address1: | 6160 MISSION GORGE RD | ||||||||
| Address2: | NO. 120 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921203410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192822232 | ||||||||
| FaxNumber: | 6192822992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2008 | ||||||||
| LastUpdateDate: | 09/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | VN175153 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.