MEDICARE: ANIBAL RAUL GAUTO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	00A367340	CA
2	2086S0129X	Vascular Surgery Physician	A36734	CA

General Provider Information

NPI Number	:	1386667780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANIBAL RAUL GAUTO M.D.

Provider Business Mailing Address
First Line	:	39300 BOB HOPE DR
Second Line	:	BANNAN BLDG 1109
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-3203
Country	:	US
Telephone Number	:	760-834-3790
Fax Number	:	760-834-3791

Provider Business Practice Location Address
First Line	:	39300 BOB HOPE DR
Second Line	:	BANNAN BLDG. 1109
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-3203
Country	:	US
Telephone Number	:	760-834-3790
Fax Number	:	760-834-3791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	02/25/2016

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