Basic Information
| Provider Information | |||||||||
| NPI: | 1154744373 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GABRIELE AESTHETICS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50470 | ||||||||
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| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911150470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266961400 | ||||||||
| FaxNumber: | 6266961452 | ||||||||
| Practice Location | |||||||||
| Address1: | 623 W DUARTE RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910077330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267922378 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2014 | ||||||||
| LastUpdateDate: | 01/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | VARGA | ||||||||
| AuthorizedOfficialFirstName: | CLAYTON | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6266961400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 11449727 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.