1487436044 NPI number — MRS. GABRIELLA LOVATO TICKNER SLPA

Table of content: ABBEY ENGSTROM (NPI 1124256912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487436044 NPI number — MRS. GABRIELLA LOVATO TICKNER SLPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TICKNER
Provider First Name:
GABRIELLA
Provider Middle Name:
LOVATO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487436044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1113 AMHERST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90049-5805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-857-8497
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1034 W OAK GROVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81403-4757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-596-7446
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com