Provider Demographics
NPI:1336626639
Name:GAN, GABRIELLE ERIN (OD)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ERIN
Last Name:GAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5559
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:14550 W SOLEDAD CANYON ROAD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-2200
Practice Address - Country:US
Practice Address - Phone:661-250-5220
Practice Address - Fax:661-250-5285
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT33973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist