Provider Demographics
NPI:1245492552
Name:GABERT, CYNTIA E (309045)
Entity type:Individual
Prefix:MRS
First Name:CYNTIA
Middle Name:E
Last Name:GABERT
Suffix:
Gender:F
Credentials:309045
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 PAMELA LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2530
Mailing Address - Country:US
Mailing Address - Phone:209-571-2075
Mailing Address - Fax:
Practice Address - Street 1:2417 PAMELA LN
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2530
Practice Address - Country:US
Practice Address - Phone:209-571-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309045163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407983570OtherREGISTERED NURSE FIRST ASSISTANT