Provider Demographics
NPI:1942551361
Name:ALANIZ, GABRIEL JOEY
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:JOEY
Last Name:ALANIZ
Suffix:
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 1:1126 N GRAND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1551
Mailing Address - Country:US
Mailing Address - Phone:626-967-1667
Mailing Address - Fax:
Practice Address - Street 1:158 N GLENDORA AVE
Practice Address - Street 2:SUITE #H
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3346
Practice Address - Country:US
Practice Address - Phone:626-222-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT96351106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist