Provider Demographics
NPI:1356864540
Name:GABRILLO, JOSEPHINE JUMANGIT (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:JUMANGIT
Last Name:GABRILLO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 BEAR MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:ARVIN
Mailing Address - State:CA
Mailing Address - Zip Code:93203-1231
Mailing Address - Country:US
Mailing Address - Phone:661-854-3131
Mailing Address - Fax:661-854-2689
Practice Address - Street 1:1305 BEAR MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:ARVIN
Practice Address - State:CA
Practice Address - Zip Code:93203-1231
Practice Address - Country:US
Practice Address - Phone:661-854-3131
Practice Address - Fax:661-854-2689
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006884363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty