Provider Demographics
NPI:1003425778
Name:NOYOLA, GABRIELLA MARIA
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:MARIA
Last Name:NOYOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S DIVISION ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-3800
Mailing Address - Country:US
Mailing Address - Phone:509-764-6644
Mailing Address - Fax:509-764-6676
Practice Address - Street 1:615 S DIVISION ST STE A
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-3800
Practice Address - Country:US
Practice Address - Phone:509-764-6644
Practice Address - Fax:509-764-6676
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician