Individual
MRS. GABRIELA BROUGHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
138 WEST MAIN STREET, SUITE E,F,G, VENTURA, CA 93001-0000
(323) 646-2997
(805) 667-2851
Mailing address
5855 OLIVAS PARK DR, VENTURA, CA 93003-7672
(805) 667-2801
(805) 641-1706
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15282
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-1683892
OTHER INSURANCE
CA
05
—
RHM08608F
—
CA
05
—
RHM08609F
—
CA
05
—
RHM18553H
—
CA
05
—
ZZT40394F
—
CA
Enumeration date
10/12/2006
Last updated
12/22/2011
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