Individual
GABRIELLE LAUREN LASALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
425 W GRAND AVE STE 1003, DAYTON, OH 45405-4776
(937) 643-9299
Mailing address
6967 MAN O WAR LN, MASON, OH 45040-3448
(513) 722-5945
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.007182RX
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/17/2021
Last updated
02/10/2022
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