Provider Demographics
NPI:1154744373
Name:GABRIELE AESTHETICS INC
Entity type:Organization
Organization Name:GABRIELE AESTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-696-1400
Mailing Address - Street 1:PO BOX 50470
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91115-0470
Mailing Address - Country:US
Mailing Address - Phone:626-696-1400
Mailing Address - Fax:626-696-1452
Practice Address - Street 1:623 W DUARTE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7330
Practice Address - Country:US
Practice Address - Phone:626-792-2378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11449727207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty