Provider Demographics
NPI:1467733659
Name:MINERA, GABRIELLA WHITTEMORE (DO)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLA
Middle Name:WHITTEMORE
Last Name:MINERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:GABRIELLA
Other - Middle Name:WHITTEMORE
Other - Last Name:BACCAGLINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7818 EXCHANGE PL
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-3703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11883207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine