Provider Demographics
NPI:1831927383
Name:SAUCEDO, GABRIELLA R
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:R
Last Name:SAUCEDO
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 1:1063 MCGAW AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5505
Mailing Address - Country:US
Mailing Address - Phone:714-616-5735
Mailing Address - Fax:
Practice Address - Street 1:1063 MCGRAW AVENUE
Practice Address - Street 2:100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614
Practice Address - Country:US
Practice Address - Phone:949-594-6582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst