Provider Demographics
NPI:1588918080
Name:GABUCAN, ALLISON KATE (RD)
Entity type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:KATE
Last Name:GABUCAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4481 WAWONA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-5133
Mailing Address - Country:US
Mailing Address - Phone:323-459-4191
Mailing Address - Fax:
Practice Address - Street 1:4481 WAWONA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-5133
Practice Address - Country:US
Practice Address - Phone:323-459-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1001340133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered