Provider Demographics
NPI:1972883676
Name:LAYSECA, GABRIELA P (MFT)
Entity type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:P
Last Name:LAYSECA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S BON VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-4408
Mailing Address - Country:US
Mailing Address - Phone:909-930-6793
Mailing Address - Fax:909-930-6798
Practice Address - Street 1:1515 S BON VIEW AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-4408
Practice Address - Country:US
Practice Address - Phone:909-930-6793
Practice Address - Fax:909-930-6798
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist