Provider Demographics
NPI:1093113839
Name:GABRILLO, JOSE PARAYNO
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:PARAYNO
Last Name:GABRILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOEY
Other - Middle Name:PARAYNO
Other - Last Name:GABRILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6304 DECLARATION WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-2786
Mailing Address - Country:US
Mailing Address - Phone:661-549-9150
Mailing Address - Fax:
Practice Address - Street 1:6304 DECLARATION WAY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-2786
Practice Address - Country:US
Practice Address - Phone:661-549-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1500135462343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)