Provider Demographics
NPI:1205209350
Name:GAFFOGLIO, SABRINA CELESTE
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:CELESTE
Last Name:GAFFOGLIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33235 OCEAN BRIGHT
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1043
Mailing Address - Country:US
Mailing Address - Phone:949-973-6466
Mailing Address - Fax:
Practice Address - Street 1:2492 WALNUT AVE STE 140
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6953
Practice Address - Country:US
Practice Address - Phone:714-544-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 9471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist