Provider Demographics
NPI:1073387783
Name:MAESTAS, GABRIELLE (MS, AMFT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:MAESTAS
Suffix:
Gender:F
Credentials:MS, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 S MARVIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-1131
Mailing Address - Country:US
Mailing Address - Phone:818-397-4174
Mailing Address - Fax:
Practice Address - Street 1:2117 S MARVIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-1131
Practice Address - Country:US
Practice Address - Phone:818-397-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142692106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist