Provider Demographics
NPI:1447581616
Name:HAMMOND, GABRIELLE (LAC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90406-1005
Mailing Address - Country:US
Mailing Address - Phone:310-910-1775
Mailing Address - Fax:310-531-7301
Practice Address - Street 1:2414 7TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3806
Practice Address - Country:US
Practice Address - Phone:310-910-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI431171100000X
CA11645171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist