Active NPI
Gabrielle Rose Nack
- Physical Therapy Assistant
- El Cajon, CA
National Provider Identifier
1013895762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 54307
- Practice address
- 1663 Greenfield Dr
El Cajon, CA 92021-3520 - Phone
- (619) 440-5752
- NPI assigned
- Aug 21, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 54307 | CA | Primary |
Addresses
Primary practice location
1663 Greenfield Dr
El Cajon, CA 92021-3520
Mailing address
5812 Arboles St
San Diego, CA 92120-3722
Phone (661) 477-2164
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54307 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755734400000",
"number": "1013895762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5812 ARBOLES ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921203722",
"telephone_number": "661-477-2164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1663 GREENFIELD DR",
"city": "EL CAJON",
"state": "CA",
"postal_code": "920213520",
"telephone_number": "619-440-5752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NACK",
"first_name": "GABRIELLE",
"middle_name": "ROSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-08-21",
"last_updated": "2025-08-21",
"certification_date": "2025-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "54307",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Cajon, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.