Provider Demographics
NPI:1073039392
Name:BIASE, GABRIELLA (LAC)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:BIASE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 MCFARLANE RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-5710
Mailing Address - Country:US
Mailing Address - Phone:510-316-5779
Mailing Address - Fax:
Practice Address - Street 1:1152 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1638
Practice Address - Country:US
Practice Address - Phone:510-316-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13344171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist