Provider Demographics
NPI:1881447910
Name:CASARES, GABRIELA
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:CASARES
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 1:4512 E GAUTHIER RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR
Mailing Address - State:MI
Mailing Address - Zip Code:49621-9606
Mailing Address - Country:US
Mailing Address - Phone:231-649-7137
Mailing Address - Fax:
Practice Address - Street 1:4512 E GAUTHIER RD
Practice Address - Street 2:
Practice Address - City:CEDAR
Practice Address - State:MI
Practice Address - Zip Code:49621-9606
Practice Address - Country:US
Practice Address - Phone:231-649-7137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker