Provider Demographics
NPI:1154094936
Name:SAN GABRIEL CLINICA
Entity Type:Organization
Organization Name:SAN GABRIEL CLINICA
Other - Org Name:GABRIEL PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ELEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, PMHNP-BC
Authorized Official - Phone:432-652-2548
Mailing Address - Street 1:1102 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-1180
Mailing Address - Country:US
Mailing Address - Phone:877-654-9139
Mailing Address - Fax:877-654-8335
Practice Address - Street 1:710 S GREGG ST # 226
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2425
Practice Address - Country:US
Practice Address - Phone:877-654-9139
Practice Address - Fax:877-654-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty