Provider Demographics
NPI:1902197437
Name:PANAMA, GABRIEL MICHAEL (MPT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:MICHAEL
Last Name:PANAMA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18604 MANDAN ST
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3712
Mailing Address - Country:US
Mailing Address - Phone:661-618-3711
Mailing Address - Fax:
Practice Address - Street 1:18604 MANDAN ST
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3712
Practice Address - Country:US
Practice Address - Phone:661-618-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic