Healthcare Provider Details

I. General information

NPI: 1235078940
Provider Name (Legal Business Name): MICHAEL THOMAS GAUT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 E JACKSON ST
LONG BEACH CA
90805-6129
US

IV. Provider business mailing address

1511 E JACKSON ST
LONG BEACH CA
90805-6129
US

V. Phone/Fax

Practice location:
  • Phone: 714-875-0543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: