Provider Demographics
NPI:1164453320
Name:CARABELLO, GABRIEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:G
Last Name:CARABELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 CALLE FORTUNA
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-3023
Mailing Address - Country:US
Mailing Address - Phone:213-700-4294
Mailing Address - Fax:323-265-4570
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE
Practice Address - Street 2:STE. 2450
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2424
Practice Address - Country:US
Practice Address - Phone:323-265-4559
Practice Address - Fax:323-265-4570
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69726208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G697260Medicaid
CAG52810Medicare UPIN
CA00G697260Medicaid