Provider Demographics
NPI:1508435264
Name:BACHAWATI, GIZELE
Entity Type:Individual
Prefix:
First Name:GIZELE
Middle Name:
Last Name:BACHAWATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 E VILLA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-2532
Mailing Address - Country:US
Mailing Address - Phone:714-357-8897
Mailing Address - Fax:
Practice Address - Street 1:2439 E VILLA VISTA WAY
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-2532
Practice Address - Country:US
Practice Address - Phone:714-357-8897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant