Provider Demographics
NPI:1992002638
Name:BUCHANAN, GABRIEL YUSEF
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:YUSEF
Last Name:BUCHANAN
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 1:4765 E IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-5834
Mailing Address - Country:US
Mailing Address - Phone:702-326-9238
Mailing Address - Fax:
Practice Address - Street 1:4765 E IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5834
Practice Address - Country:US
Practice Address - Phone:702-326-9238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20111108715103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst