Provider Demographics
NPI:1346002359
Name:COSTACHE, GABRIEL ELIAS
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ELIAS
Last Name:COSTACHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:ELIZA
Other - Last Name:COSTACHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 S BLACKHAWK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1488
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121 S BLACKHAWK ST STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1488
Practice Address - Country:US
Practice Address - Phone:720-545-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician