Healthcare Provider Details

I. General information

NPI: 1861509929
Provider Name (Legal Business Name): GLORIA GONZALES TRAJE-QUITORIANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 TUOLUMNE ST
FRESNO CA
93721-1227
US

IV. Provider business mailing address

2640 TUOLUMNE ST
FRESNO CA
93721-1227
US

V. Phone/Fax

Practice location:
  • Phone: 559-442-0111
  • Fax: 559-442-4822
Mailing address:
  • Phone: 559-442-0111
  • Fax: 559-442-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA42040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: