Provider Demographics
NPI:1306671078
Name:ESPINOZA, GABRIELA
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:ESPINOZA
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:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95415-0338
Mailing Address - Country:US
Mailing Address - Phone:707-895-3477
Mailing Address - Fax:
Practice Address - Street 1:13500 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95415-9133
Practice Address - Country:US
Practice Address - Phone:707-895-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36619124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist