Provider Demographics
NPI:1467294934
Name:BASCARA, GABRIEL INCLETO
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:INCLETO
Last Name:BASCARA
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 1:140 DOLPHIN CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-3324
Mailing Address - Country:US
Mailing Address - Phone:707-319-6368
Mailing Address - Fax:
Practice Address - Street 1:140 DOLPHIN CT
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-3324
Practice Address - Country:US
Practice Address - Phone:707-319-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant