Provider Demographics
NPI:1497347355
Name:GABRIEL, GERON DALE POSADAS
Entity Type:Individual
Prefix:
First Name:GERON DALE
Middle Name:POSADAS
Last Name:GABRIEL
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 1:117 S HOOVER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-6917
Mailing Address - Country:US
Mailing Address - Phone:213-448-1999
Mailing Address - Fax:
Practice Address - Street 1:1346 FOOTHILL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2131
Practice Address - Country:US
Practice Address - Phone:818-790-3001
Practice Address - Fax:818-790-9732
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA48419225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant