Provider Demographics
NPI:1841448917
Name:GABRIEL, EPHRAIM MOLLA (MD, MPH)
Entity type:Individual
Prefix:
First Name:EPHRAIM
Middle Name:MOLLA
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18862 DUKAS ST
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2133
Mailing Address - Country:US
Mailing Address - Phone:651-233-0233
Mailing Address - Fax:
Practice Address - Street 1:16300 ROSCOE BLVD STE A1
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1246
Practice Address - Country:US
Practice Address - Phone:818-893-4426
Practice Address - Fax:818-894-7564
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1143232083P0901X, 2083X0100X
FLME1083832083X0100X
GA637772083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME108383OtherFLORIDA PHYSICIAN LICENSE
GA63777OtherGEORGIA PHYSICIAN LICENSE
CAA114323OtherCALIFORNIA PHYSICIAN LICENSE