Provider Demographics
NPI:1194257782
Name:GAGUI, HAZEL MARIE CERIO (PT)
Entity type:Individual
Prefix:MRS
First Name:HAZEL MARIE
Middle Name:CERIO
Last Name:GAGUI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 JACARANDA ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-6355
Mailing Address - Country:US
Mailing Address - Phone:203-809-4061
Mailing Address - Fax:
Practice Address - Street 1:541 JACARANDA ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-6355
Practice Address - Country:US
Practice Address - Phone:203-809-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist