Individual
DR. GABRIELLE BOSLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6501 BEDFORD AVE, LOS ANGELES, CA 90056-2101
(708) 203-6659
Mailing address
6501 BEDFORD AVE, LOS ANGELES, CA 90056-2101
(708) 203-6659
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036097300
IL
2085R0202X
Diagnostic Radiology Physician
Primary
G77639
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036097300
—
IL
01
—
1618334
BCBS ID
IL
Enumeration date
09/13/2006
Last updated
11/19/2020
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