Provider Demographics
NPI:1447491964
Name:SWEIDAN, GABRIELA E
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:E
Last Name:SWEIDAN
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 1:4570 CAMPUS DR
Mailing Address - Street 2:SUITE #8
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8809
Mailing Address - Country:US
Mailing Address - Phone:949-375-7276
Mailing Address - Fax:949-706-0792
Practice Address - Street 1:4570 CAMPUS DR.
Practice Address - Street 2:SUITE # 8
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-375-7276
Practice Address - Fax:949-706-0792
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20654103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical