Provider Demographics
NPI:1114808953
Name:RAUTI, GABRIELLA ROSE
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:ROSE
Last Name:RAUTI
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 1:22274 DONALDSON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4707
Mailing Address - Country:US
Mailing Address - Phone:313-600-3034
Mailing Address - Fax:
Practice Address - Street 1:22274 DONALDSON ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4707
Practice Address - Country:US
Practice Address - Phone:313-600-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant