Provider Demographics
NPI:1093021693
Name:GABRIEL, EVETTE BOSHRA ZIKRY (PA)
Entity Type:Individual
Prefix:
First Name:EVETTE
Middle Name:BOSHRA ZIKRY
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3152 N MILLBROOK AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1400
Mailing Address - Country:US
Mailing Address - Phone:559-917-8615
Mailing Address - Fax:
Practice Address - Street 1:3152 N MILLBROOK AVE
Practice Address - Street 2:SUITE C
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1400
Practice Address - Country:US
Practice Address - Phone:559-917-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA21072363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant