Provider Demographics
NPI:1790366060
Name:HIRALES, GABRIEL JOHN JR
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:JOHN
Last Name:HIRALES
Suffix:JR
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 1:13920 CITY CENTER DR STE 290
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5444
Mailing Address - Country:US
Mailing Address - Phone:866-351-8887
Mailing Address - Fax:626-737-1095
Practice Address - Street 1:13920 CITY CENTER DR STE 290
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5444
Practice Address - Country:US
Practice Address - Phone:866-351-8887
Practice Address - Fax:626-737-1095
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician