Provider Demographics
NPI:1306665799
Name:LIEN, GABRIELA LYNN
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:LYNN
Last Name:LIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:LYNN
Other - Last Name:HUFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2306 E BALBOA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4104
Mailing Address - Country:US
Mailing Address - Phone:928-279-5733
Mailing Address - Fax:
Practice Address - Street 1:21803 N SCOTTSDALE RD STE 200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7446
Practice Address - Country:US
Practice Address - Phone:480-500-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant