Healthcare Provider Details

I. General information

NPI: 1629994058
Provider Name (Legal Business Name): MONICA J GAYTAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 LIMONITE AVE
JURUPA VALLEY CA
92509-5174
US

IV. Provider business mailing address

5575 BEACH ST
JURUPA VALLEY CA
92509-4838
US

V. Phone/Fax

Practice location:
  • Phone: 951-544-2751
  • Fax:
Mailing address:
  • Phone: 951-544-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: