Provider Demographics
NPI:1164257697
Name:LIBOIRON-COHEN, GABRIEL ALEXANDER (AUD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:ALEXANDER
Last Name:LIBOIRON-COHEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2240
Mailing Address - Country:US
Mailing Address - Phone:510-841-0681
Mailing Address - Fax:
Practice Address - Street 1:2748 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2240
Practice Address - Country:US
Practice Address - Phone:510-841-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
CAAU3952231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter