Provider Demographics
NPI:1285899625
Name:GABASAN, DIANE GONZALEZ (RPH)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:GONZALEZ
Last Name:GABASAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 BALSAM WILLOW TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4410
Mailing Address - Country:US
Mailing Address - Phone:845-300-8323
Mailing Address - Fax:407-401-9855
Practice Address - Street 1:10425 NARCOOSSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6902
Practice Address - Country:US
Practice Address - Phone:407-384-9353
Practice Address - Fax:407-384-1226
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41017183500000X
NJ28RI0300000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist