Provider Demographics
NPI:1144052259
Name:OSEGUERA, GABRIEL ADRIAN
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ADRIAN
Last Name:OSEGUERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 SOUTHPORT DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-7081
Mailing Address - Country:US
Mailing Address - Phone:843-970-1011
Mailing Address - Fax:
Practice Address - Street 1:187 SOUTHPORT DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7081
Practice Address - Country:US
Practice Address - Phone:843-970-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12312225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist