Provider Demographics
NPI:1124043138
Name:GABBAY, NILOUFAR (PA)
Entity Type:Individual
Prefix:
First Name:NILOUFAR
Middle Name:
Last Name:GABBAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 POWELL ST
Mailing Address - Street 2:SUITE 920
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1826
Mailing Address - Country:US
Mailing Address - Phone:510-350-2777
Mailing Address - Fax:510-879-9100
Practice Address - Street 1:2100 POWELL ST
Practice Address - Street 2:SUITE 920
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1826
Practice Address - Country:US
Practice Address - Phone:510-350-2777
Practice Address - Fax:510-879-9100
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17461363A00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17461Medicaid
CAQ30008Medicare UPIN
CAPA17461Medicaid