Provider Demographics
NPI:1194969147
Name:KESSELMAN, GABRIEL DAVID (LAC)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:DAVID
Last Name:KESSELMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:928 FORT STOCKTON DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1881
Mailing Address - Country:US
Mailing Address - Phone:619-692-0692
Mailing Address - Fax:619-692-0600
Practice Address - Street 1:928 FORT STOCKTON DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1881
Practice Address - Country:US
Practice Address - Phone:619-692-0692
Practice Address - Fax:619-692-0600
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12999171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist