Provider Demographics
NPI:1518375476
Name:SOMARRIBA, GABRIEL (PSYD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:SOMARRIBA
Suffix:
Gender:M
Credentials:PSYD
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 391057
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-8057
Mailing Address - Country:US
Mailing Address - Phone:440-668-8564
Mailing Address - Fax:877-844-4869
Practice Address - Street 1:6575 ASHTON LN
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3213
Practice Address - Country:US
Practice Address - Phone:440-668-8564
Practice Address - Fax:877-844-4869
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7450103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0185103Medicaid
OH0185103Medicaid