Provider Demographics
NPI:1780001164
Name:GABRAEIL, PETER SR
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:GABRAEIL
Suffix:SR
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 1:13023 S MANHATTAN PL
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-1906
Mailing Address - Country:US
Mailing Address - Phone:714-728-2342
Mailing Address - Fax:424-488-2308
Practice Address - Street 1:13023 S MANHATTAN PL
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-1906
Practice Address - Country:US
Practice Address - Phone:714-728-2342
Practice Address - Fax:424-488-2308
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver