Provider Demographics
NPI:1932671336
Name:SEPULVEDA, GABRIEL (RBT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3824
Mailing Address - Country:US
Mailing Address - Phone:619-730-5448
Mailing Address - Fax:
Practice Address - Street 1:2226 E 11TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3824
Practice Address - Country:US
Practice Address - Phone:619-730-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-23
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA1140831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician