Provider Demographics
NPI:1659984078
Name:SAN GABRIEL CLINIC
Entity Type:Organization
Organization Name:SAN GABRIEL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:760-666-7405
Mailing Address - Street 1:864 E QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2107
Mailing Address - Country:US
Mailing Address - Phone:559-917-8615
Mailing Address - Fax:
Practice Address - Street 1:3231 WARING CT STE B
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4510
Practice Address - Country:US
Practice Address - Phone:760-666-7405
Practice Address - Fax:760-666-7562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty