Provider Demographics
NPI:1518434984
Name:NICOLAS, GILDEBRAND GABERTAN
Entity Type:Individual
Prefix:
First Name:GILDEBRAND
Middle Name:GABERTAN
Last Name:NICOLAS
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 1:2680 AMALFI
Mailing Address - Street 2:
Mailing Address - City:CHOWCHILLA
Mailing Address - State:CA
Mailing Address - Zip Code:93610-9453
Mailing Address - Country:US
Mailing Address - Phone:559-232-0402
Mailing Address - Fax:
Practice Address - Street 1:2680 AMALFI
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-9453
Practice Address - Country:US
Practice Address - Phone:559-232-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84592251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics