Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | PTL4907 | CA |
NPI | 1023636073 |
---|---|
Provider Name | Samy Gabriel |
First Address | San Diego, CA 92109-1027 |
Second Address | San Diego, CA 92103-1911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2020 |
Last Update Date | 13/07/2021 |