Provider Demographics
NPI:1760166995
Name:MACIAS, GABRIELA GUADALUPE
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:GUADALUPE
Last Name:MACIAS
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 1:200 WISTERIA ST
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-2245
Mailing Address - Country:US
Mailing Address - Phone:818-860-6170
Mailing Address - Fax:
Practice Address - Street 1:200 WISTERIA ST
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-2245
Practice Address - Country:US
Practice Address - Phone:818-860-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician