Provider Demographics
NPI:1154906014
Name:BROSIUS, GABRIEL MATTEO
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:MATTEO
Last Name:BROSIUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 OLD HWY 8 SUITE 101F
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121
Mailing Address - Country:US
Mailing Address - Phone:619-471-5686
Mailing Address - Fax:
Practice Address - Street 1:SENZILLA HEALTH SERVICES LLC
Practice Address - Street 2:3055 OLD HWY 8 STE 101F
Practice Address - City:SAINT ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-5541
Practice Address - Country:US
Practice Address - Phone:612-259-7715
Practice Address - Fax:612-259-7889
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst