Provider Demographics
NPI:1932878105
Name:ARTIS, GABRIELLE MIRIAM (MED, PPS)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MIRIAM
Last Name:ARTIS
Suffix:
Gender:F
Credentials:MED, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4554 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3033
Mailing Address - Country:US
Mailing Address - Phone:240-643-0803
Mailing Address - Fax:
Practice Address - Street 1:1254 E HELMICK ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3164
Practice Address - Country:US
Practice Address - Phone:310-637-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool