Provider Demographics
NPI:1568875961
Name:ANTAO, GABRIELA GARGANTA
Entity Type:Individual
Prefix:MS
First Name:GABRIELA
Middle Name:GARGANTA
Last Name:ANTAO
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 1:4011 BIG HORN RD # 6H
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81657-4995
Mailing Address - Country:US
Mailing Address - Phone:908-720-6074
Mailing Address - Fax:
Practice Address - Street 1:4011 BIG HORN RD # 6H
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-4995
Practice Address - Country:US
Practice Address - Phone:908-720-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00677600235Z00000X
CO0001692235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist