Healthcare Provider Details

I. General information

NPI: 1306170972
Provider Name (Legal Business Name): ALDEN GAJO M D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 WEST AVE Q SUITE D
PALMDALE CA
93551-4832
US

IV. Provider business mailing address

40226 TESORO LN
PALMDALE CA
93551-4832
US

V. Phone/Fax

Practice location:
  • Phone: 661-272-5656
  • Fax: 661-272-0909
Mailing address:
  • Phone: 702-219-1560
  • Fax: 661-266-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA049002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: