Provider Demographics
NPI:1952351777
Name:GABRIEL, NICK HADRIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:HADRIAN
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2526 SISTER MARY COLUMBA DR FL 1
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080
Practice Address - Country:US
Practice Address - Phone:530-528-3150
Practice Address - Fax:530-528-3596
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006810208600000X
NY200259208600000X
CA20A17467208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02126956Medicaid
NY02126956Medicaid