Provider Demographics
NPI:1124825856
Name:GOYTIA, GABRIELLA STANTON (RDH, OMT)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:STANTON
Last Name:GOYTIA
Suffix:
Gender:
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6745 GROUND IVY CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9143
Mailing Address - Country:US
Mailing Address - Phone:951-403-5134
Mailing Address - Fax:
Practice Address - Street 1:6745 GROUND IVY CT
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-9143
Practice Address - Country:US
Practice Address - Phone:951-403-5134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24559124Q00000X
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist