Provider Demographics
NPI:1760210876
Name:GBRAAEL, SOZANA JR
Entity type:Individual
Prefix:
First Name:SOZANA
Middle Name:
Last Name:GBRAAEL
Suffix:JR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 BARCELONA WAY
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4701
Mailing Address - Country:US
Mailing Address - Phone:510-938-2289
Mailing Address - Fax:
Practice Address - Street 1:4651 BARCELONA WAY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-4701
Practice Address - Country:US
Practice Address - Phone:510-938-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202357911123103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling