Provider Demographics
NPI:1649625740
Name:GABBITA, VIJAY M SR
Entity type:Individual
Prefix:MR
First Name:VIJAY
Middle Name:M
Last Name:GABBITA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:VIJAY
Other - Middle Name:M
Other - Last Name:GABBITA
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:SR
Mailing Address - Street 1:10513 ZENOR LN UNIT 34
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-6810
Mailing Address - Country:US
Mailing Address - Phone:858-395-7555
Mailing Address - Fax:
Practice Address - Street 1:10513 ZENOR LN UNIT 34
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-6810
Practice Address - Country:US
Practice Address - Phone:858-395-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4NGJ402125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist