Provider Demographics
NPI:1164812590
Name:ROSAS, GABRIELA (OTD, IBCLC)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:ROSAS
Suffix:
Gender:F
Credentials:OTD, IBCLC
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:
Other - Last Name:GALAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21107 VICTOR ST
Mailing Address - Street 2:APT 29
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21107 VICTOR ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2841
Practice Address - Country:US
Practice Address - Phone:310-951-8102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-311201174N00000X
CA14872225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No174N00000XOther Service ProvidersLactation Consultant, Non-RN