Provider Demographics
NPI:1003351735
Name:GOROSTIETA, GABRIELA (NP)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:GOROSTIETA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43535 17TH ST W STE 402
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5984
Mailing Address - Country:US
Mailing Address - Phone:818-239-9530
Mailing Address - Fax:
Practice Address - Street 1:43535 17TH ST W STE 402
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5984
Practice Address - Country:US
Practice Address - Phone:818-239-9530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA846884163W00000X
CA95030025363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse