Provider Demographics
NPI:1659823029
Name:ACEVES, GABRIEL ANDREW
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ANDREW
Last Name:ACEVES
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 1:2716 WARREN WAY
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-8446
Mailing Address - Country:US
Mailing Address - Phone:424-258-5987
Mailing Address - Fax:888-859-0145
Practice Address - Street 1:2716 WARREN WAY
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-8446
Practice Address - Country:US
Practice Address - Phone:424-258-5987
Practice Address - Fax:888-859-0145
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist