Provider Demographics
NPI:1548047277
Name:VITEZ, GABRIELLE G
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:G
Last Name:VITEZ
Suffix:
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 1:274 S HAMETOWN RD
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1245
Mailing Address - Country:US
Mailing Address - Phone:330-962-5262
Mailing Address - Fax:
Practice Address - Street 1:158 N CARPENTER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-1352
Practice Address - Country:US
Practice Address - Phone:330-962-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care