Provider Demographics
NPI:1174233597
Name:HEIGL, GABRIELA
Entity type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:
Last Name:HEIGL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GABRIELA
Other - Middle Name:
Other - Last Name:NODINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 E COLTON AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3840
Mailing Address - Country:US
Mailing Address - Phone:909-754-4643
Mailing Address - Fax:
Practice Address - Street 1:4160 TEMESCAL CANYON RD STE 309
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-4629
Practice Address - Country:US
Practice Address - Phone:909-754-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127811106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist