Provider Demographics
NPI:1205391505
Name:VALLES, GABRIEL ANTHONY
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ANTHONY
Last Name:VALLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 BOWSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-6750
Mailing Address - Country:US
Mailing Address - Phone:720-380-9446
Mailing Address - Fax:
Practice Address - Street 1:2139 BOWSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-6750
Practice Address - Country:US
Practice Address - Phone:720-380-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services