Provider Demographics
NPI:1306235106
Name:PABALAN, MARIAGISELA
Entity type:Individual
Prefix:
First Name:MARIAGISELA
Middle Name:
Last Name:PABALAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-1519
Mailing Address - Country:US
Mailing Address - Phone:619-202-4530
Mailing Address - Fax:
Practice Address - Street 1:220 E 24TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-6705
Practice Address - Country:US
Practice Address - Phone:619-474-6741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant