Provider Demographics
NPI:1801678800
Name:HERON, GABRIELLE MARGUERITE
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MARGUERITE
Last Name:HERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-1734
Mailing Address - Country:US
Mailing Address - Phone:805-363-0997
Mailing Address - Fax:
Practice Address - Street 1:37 MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-1734
Practice Address - Country:US
Practice Address - Phone:805-363-0997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker