Provider Demographics
NPI:1255735593
Name:ZENOVIA H GABRIEL, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ZENOVIA H GABRIEL, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZENOVIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-200-8222
Mailing Address - Street 1:1402 EMERALD BAY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1277
Mailing Address - Country:US
Mailing Address - Phone:949-200-8222
Mailing Address - Fax:949-612-1662
Practice Address - Street 1:359 SAN MIGUEL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7812
Practice Address - Country:US
Practice Address - Phone:949-200-8222
Practice Address - Fax:949-612-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty