Provider Demographics
NPI:1659722320
Name:PERPETUA, GABRIEL MILO JR (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:MILO
Last Name:PERPETUA
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29645 RANCHO CALIFORNIA RD
Mailing Address - Street 2:STE. 234
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6200
Mailing Address - Country:US
Mailing Address - Phone:951-506-3001
Mailing Address - Fax:951-506-3002
Practice Address - Street 1:215 S HICKORY ST
Practice Address - Street 2:SUITE 112
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4359
Practice Address - Country:US
Practice Address - Phone:760-737-8460
Practice Address - Fax:760-739-5669
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA34996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB258966Medicare PIN