Provider Demographics
NPI:1972139020
Name:UPPALA, GAEA JAMINE UMALI (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:GAEA JAMINE
Middle Name:UMALI
Last Name:UPPALA
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:GAEA JAMINE
Other - Middle Name:BUZO
Other - Last Name:UMALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, PMHNP-BC
Mailing Address - Street 1:26372 ANTONIO CIR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6726
Mailing Address - Country:US
Mailing Address - Phone:909-754-3633
Mailing Address - Fax:
Practice Address - Street 1:461 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8167
Practice Address - Country:US
Practice Address - Phone:909-475-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA95015727363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program