Provider Demographics
NPI:1144666355
Name:GARZA SADA, GABRIEL MAURICIO (PHD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:MAURICIO
Last Name:GARZA SADA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:GABRIEL
Other - Middle Name:MAURICIO
Other - Last Name:GARZA SADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:707 SABLE OAKS DR STE 230
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6954
Mailing Address - Country:US
Mailing Address - Phone:603-883-0005
Mailing Address - Fax:
Practice Address - Street 1:707 SABLE OAKS DR STE 230
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6954
Practice Address - Country:US
Practice Address - Phone:603-883-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06555103TC2200X
MEPS2559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent