Individual
MADISON GAVELA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
760 ENCINITAS BLVD STE 208, ENCINITAS, CA 92024-3307
(760) 815-8162
Mailing address
17908 LARIAT DR, CHINO HILLS, CA 91709-3234
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/18/2019
Last updated
06/18/2019
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