Provider Demographics
NPI:1225315906
Name:SIEGEL, GABRIELLA CALO (PSYD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLA
Middle Name:CALO
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-1464
Mailing Address - Country:US
Mailing Address - Phone:424-234-6169
Mailing Address - Fax:310-870-3812
Practice Address - Street 1:8549 WILSHIRE BLVD UNIT 3142
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3104
Practice Address - Country:US
Practice Address - Phone:424-234-6169
Practice Address - Fax:310-870-3812
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24517102L00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist