Provider Demographics
NPI:1457003634
Name:SHAFER, GIGI NACIONAL
Entity Type:Individual
Prefix:
First Name:GIGI
Middle Name:NACIONAL
Last Name:SHAFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GIGI
Other - Middle Name:FLORES
Other - Last Name:NACIONAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2009 LAS ESTRELLAS COURT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012
Mailing Address - Country:US
Mailing Address - Phone:805-407-4533
Mailing Address - Fax:805-384-2724
Practice Address - Street 1:2009 LAS ESTRELLAS COURT
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012
Practice Address - Country:US
Practice Address - Phone:805-407-4533
Practice Address - Fax:805-384-2724
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty